Proximal humerus fractures are common, and about 80% are well managed nonsurgically. The remaining 20% present a therapeutic challenge because surgical stabilization is necessary to ensure healing and to optimize function. The priorities in surgical stabilization of proximal humerus fractures are (1) restoring the anatomic relationship between the tuberosities and the articular head fragment and (2) maintaining vascularity of the articular fragment. Open reduction and internal fixation may allow for rigid fracture fixation, but soft-tissue dissection may endanger residual vascularity of the articular segment. Closed reduction followed by percutaneous fixation reduces risk from soft-tissue dissection and may reduce the fracture indirectly, achieving provisional fixation for anatomic healing. This technique requires meticulous attention to detail and teamwork among the surgeon, surgical assistants, nursing staff, and anesthesia staff.

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