--- title: "Shoulder Fracture Fixation (ORIF) | Dr. Avi Chezar" description: "Plate-and-screw fixation (ORIF) of upper humerus fractures: when fixation is chosen over joint replacement, how the operation is done, recovery and risks." canonical: https://www.catef4u.com/en/fracture-fixation translation-of: https://www.catef4u.com/fracture-fixation last-updated: 2026-11-03 language: en source: catef4u.com --- # Shoulder Fracture Fixation with a Plate and Screws > Plate-and-screw fixation (ORIF) of upper humerus fractures: when fixation is chosen over joint replacement, how the operation is done, recovery and risks. Open reduction internal fixation (ORIF) of proximal humerus fractures ## In brief Summarized and reviewed by Dr. Avi Chezar, shoulder surgery specialist, Assuta Haifa and RMC Afula. **What it is:** Open reduction and internal fixation (ORIF) for fractures of the head of the humerus at the shoulder. The aim is to return the fracture to its original position and fix it there, to allow the best possible shoulder function. **When:** For a fracture with significant displacement when, without surgery, function would be poor. The younger the patient, the more fixation is preferred over joint replacement; above age 70 replacement is usually preferred. **Diagnosis:** X-ray and CT before surgery for planning; real-time X-ray (fluoroscopy) during the operation to confirm the position of the plate and screws. **The surgery:** Open surgery through an incision at the front of the shoulder, under general anesthesia; the broken parts are fixed with a titanium plate and screws, which are not usually removed afterwards. After 3–4 weeks in a sling, physiotherapy begins; reasonable daily function within 3 months. This article covers fractures of the upper arm bone, the humerus, at the shoulder. ## When is a fracture fixed? The operation is performed for a fracture with significant displacement, when it is judged that without surgery shoulder function will be poor. Note, however, that with very severe fractures, mainly in older patients above 70, we prefer a partial or total joint replacement (see the relevant articles: [partial replacement](https://www.catef4u.com/en/partial-shoulder-replacement), [reverse replacement for fractures](https://www.catef4u.com/en/reverse-shoulder-fracture)). The reason is that in older patients the chance of the fracture healing and the operation succeeding is lower. The younger the patient, the more we prefer fixing the fracture over replacing the joint. ## What is the goal of the operation? The goal of the operation is to return the fracture as close as possible to its original position and to fix it in that position. The aim is to allow the best possible shoulder function. This is usually a complex injury, and even after surgery some limitation of shoulder function is expected. ## How is the operation performed? The operation is done with an open technique, that is, through an incision at the front or the side of the shoulder. It is performed under general anesthesia, usually combined with regional anesthesia. - **The first stage of the operation** is the approach: through the incision the fracture area is reached and the broken parts are identified. - **The second stage**: the parts are returned to their place, and usually the fracture is temporarily fixed. To make sure the parts are in place, an X-ray taken during the operation (fluoroscopy) is used. - **The third stage**: the broken parts are fixed, usually with a plate and screws. This stage is also done with the help of fluoroscopy. If the tendons are injured, sutures are used to repair them. - **The fourth stage**: the layers and the skin are closed. In certain situations a tube is left to drain blood and fluid from the fracture area. The arm is immobilized in a sling. ## What happens after the operation? Usually the arm is immobilized in a sling for about 3–4 weeks, and then physiotherapy begins. In the first months function is relatively limited and the movements are mainly passive. Reasonable daily function can be expected after about 3 months, and relatively good function after about 6 months. Shoulder function keeps improving during the first year after surgery, and slowly after that as well. Keep in mind that in any case some restriction of movement is expected even at the end of rehabilitation. ## What are the risks and complications? Some complications can occur during the operation: injury to blood vessels, injury to nerves, and complications related to general anesthesia. The risk of an anesthesia complication depends on the patient's underlying illnesses and age. Late complications include: non-union of the fracture, restricted movement after the operation, and infection. ## How does the fixation join the fracture? The purpose of the fixation is to hold the bones in place until the natural healing process of the fracture takes place. Fracture healing usually takes several months. Once the fracture has healed, the fixation no longer plays any role. ## Does the fixation need to be removed after the fracture heals? The plate and screws sit deep under the muscles and usually do not cause any problem. It is not standard practice to remove the fixation, except in special cases. Keep in mind that removing the fixation requires another operation and further damage to tissues. ## What is the fixation made of? Today most systems are made of titanium or stainless steel. ## Will the fixation set off the alarm at the airport? Fixation implants can set off the alarm, but because the amount of metal is usually not large, it is quite possible that there will be no alarm. If the alarm does go off, show the surgical scar and explain that you have had an operation. ## Further reading from leading medical sources - [Shoulder Trauma (Fractures and Dislocations) — OrthoInfo (AAOS)](https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-trauma-fractures-and-dislocations/) – Shoulder fractures and open reduction internal fixation (ORIF) --- Canonical HTML: https://www.catef4u.com/en/fracture-fixation Hebrew original: https://www.catef4u.com/fracture-fixation Site index for agents: https://www.catef4u.com/llms.txt _This Markdown is the text-only variant of the page above, served for `Accept: text/markdown`. It is an English translation of Dr. Avi Chezar's Hebrew page. Medical information here is general and does not replace a personal consultation._