Proximal Humerus ORIF (Plate Fixation)
in Rockhampton

What is going on

Proximal humerus fractures occur most commonly after a fall onto the shoulder or outstretched hand, and they are the third most common fracture in older adults. Younger patients sustain these fractures from higher-energy injuries — sport, falls from height, or motor vehicle crashes. The fracture pattern ranges from a stable single-part fracture that does not need surgery, through displaced two- and three-part fractures where the rotator cuff has pulled the tuberosity fragments out of position, to complex four-part patterns where the head, the tuberosities and the shaft are all separated. Patient factors — bone quality, age, activity level and cuff status — matter as much as the fracture geometry in deciding the right operation.

Not sure if this is the right diagnosis? The shoulder pain hub and shoulder injury hub triage the differential by anatomical location.

What the operation involves

The operation is performed under regional and general anaesthesia in the beach-chair position, through an incision over the front of the shoulder. The fracture fragments are mobilised, reduced anatomically, and held with a pre-contoured locking plate placed on the outer surface of the proximal humerus. Locking screws engage the dense subchondral bone of the humeral head to provide stable fixation even in osteoporotic bone. Calcar screws and suture augmentation through the rotator cuff insertion are used routinely to reinforce the construct against the typical varus collapse pattern seen with plate fixation. The operation usually takes one to two hours; patients stay one or two nights in hospital. Full clinical detail is on the education page.

For full clinical detail — incision, anaesthetic, post-operative instructions and the printable patient handout — see the proximal humerus orif education page or the shoulder surgery overview.

How this case is handled

In-person review at two weeks for wound check and X-ray, six weeks to confirm early union and start active motion, three months to add strengthening, and six months for the functional outcome assessment. Co-located shoulder physiotherapy is integrated into the post-operative pathway with structured progression matched to the radiographic healing. The hardware is usually retained permanently; removal is considered only if it becomes prominent or symptomatic after complete union, typically at a year or more from the index operation.

Fees, Medicare rebates and the surgery-quote process are on the fees page. The case for seeing a fellowship-trained surgeon — and what fellowship training adds — is set out separately. GPs can find the referral pathway, urgency triage and what to include in the letter on the referrer page.

What this operation is billed under

The procedure is covered by the following Medicare Benefits Schedule items. Surgeon, anaesthetist, assistant, hospital and prosthesis fees are quoted separately and in writing before surgery — see the fees page for the practice's quote process and an explanation of why surgical fees follow the Australian Medical Association schedule. Surgery does not proceed without itemised written informed financial consent.

Item 47432 Intra-articular proximal humerus fracture, open reduction with fixation

Used when the joint surface is involved — typical for displaced three- and four-part fractures

Item 47429 Extra-articular proximal humerus fracture, open reduction

Used when the joint surface is not involved

Patient questions we hear most

• Why fix the fracture instead of just using a sling?

  Stable, minimally displaced proximal humerus fractures heal reliably in a sling and do not need surgery. The threshold for offering ORIF is displacement that, if allowed to heal as is, would compromise the long-term function of the shoulder — most commonly varus collapse, where the head tilts inward and reduces the working length of the rotator cuff. Operating restores anatomy, allows earlier mobilisation and gives a more predictable functional result for displaced patterns. The trade-off is the surgical risk and the hardware, which is acceptable in most active patients but is weighed carefully in frailer or older patients where reverse shoulder arthroplasty may be the better option.

• What's the difference between ORIF and a shoulder replacement?

  ORIF preserves the patient's own joint by realigning the fracture fragments and holding them with a plate and screws. It works well when the bone quality is good, the fragments are reconstructable, and the blood supply to the head is preserved. Reverse shoulder arthroplasty replaces the joint with a prosthesis and is offered when the fracture pattern is unreconstructable, the bone quality is poor, or the pre-existing cuff function is compromised. The decision is individual; both pathways are discussed at the pre-operative consult and the trade-offs in expected recovery, durability and risk are mapped out.

• Will the plate need to be removed?

  The plate is usually left in place for life. Removal is considered only when the hardware causes ongoing symptoms after complete fracture union — most commonly a prominent screw or plate edge that the patient can feel under the skin or when lying on the shoulder. Hardware removal is a smaller second operation, usually performed at a year or more from the index operation once the bone has fully consolidated.

• How much does proximal humerus ORIF cost? What does Medicare cover?

  ORIF involves separate fees for the surgeon, anaesthetist, hospital and the surgical implants (plate and screws). The practice quotes the surgical fee in writing before booking — the Medicare item, the rebate and the out-of-pocket gap each shown separately. Dr Hirpara's surgical fees follow the Australian Medical Association schedule, which is higher than the Medicare scheduled fee; the fees page explains why. Surgery does not proceed without itemised written informed financial consent.

• What can go wrong?

  The most common issue is varus collapse of the humeral head, where the fixation construct loses position before the bone fully heals — more common in osteoporotic bone and large head-shaft displacement. Avascular necrosis of the humeral head can occur weeks to months after surgery, particularly in fracture patterns where the head's blood supply was disrupted, and may eventually require conversion to arthroplasty. Infection is uncommon but serious. Stiffness is the most common nuisance complication and is mitigated by early passive motion and structured physiotherapy. Individual risk and the trade-off with reverse arthroplasty are discussed at the pre-operative consult.

More general questions about appointments, fees and the practice on the FAQ page.