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Shoulder fracture treatment - the right pathway, not a reflex operation.

Proximal humerus, clavicle, scapula and greater tuberosity fractures - from a conservative sling pathway through ORIF, intramedullary nail and reverse shoulder arthroplasty. A consultant shoulder-trauma surgeon, the PROFHER conversation up front, and NHS trauma pathways on the table when they fit better.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private shoulder fracture treatment costs in the UK.

Indicative ranges across our partner upper-limb trauma units.

In short

Conservative pathway £600–£1,500, proximal humerus ORIF £8,000–£14,000, reverse arthroplasty for fracture £16,000–£24,000.

Procedure Indicative range
Conservative pathway (sling, physio, follow-up X-rays) £600–£1,500
ORIF proximal humerus (locking plate) £8,000–£14,000
Intramedullary nail, proximal humerus £7,500–£12,000
Clavicle ORIF (plate and screws) £5,500–£9,000
Greater tuberosity fixation £6,000–£10,000
Reverse shoulder arthroplasty for fracture £16,000–£24,000
Orthopaedic consultation (second opinion) £250–£450
CT shoulder with 3D reconstruction £450–£850

Acute shoulder trauma is almost always NHS territory in the first instance. Private care fits best for a second opinion on the A&E plan, elective delayed fixation, revision of a non-union, and structured post-injury physiotherapy. Reverse arthroplasty for fracture is done well in both settings; surgeon volume matters more than the badge on the door.

The problem

The right classification, the right pathway, and the operation you actually need.

Shoulder fracture care is where general trauma quietly under-delivers - the Neer pattern is called by the resident, the PROFHER conversation is skipped, and the physiotherapy that decides the final range is booked too late.

  • Classify the pattern properly

    A displaced 3-part proximal humerus behaves nothing like a 2-part or a head-splitting fracture. A CT with 3D reconstruction is not a luxury for the borderline cases.

  • PROFHER before the plate

    Most displaced 2-part proximal humerus fractures do as well in a sling as in theatre. We share the trial data before quoting for ORIF.

  • Physio decides the range

    Sling or plate, the last 30 degrees of overhead reach is earned in the physio room.

The journey

From A&E to full range - what happens, in order.

One team from first message through the operation or sling pathway and the 12 weeks of physiotherapy that follow.

  1. 01

    Before

    A short confidential form. Date of the fall, side, imaging done in A&E, current sling, hand dominance, occupation, any history of osteoporosis or diabetes.

  2. 02

    Before

    Indicative price for each route.

  3. 03

    Before

    CT and 3D reconstruction where indicated

    A plain X-ray classifies most clavicle and simple humeral fractures. Displaced 3- and 4-part proximal humerus patterns get a CT with 3D reconstruction to plan fixation or arthroplasty properly.

  4. 04

    Before

    Second opinion, or straight to theatre

    Many patients come to us for a review of the A&E plan.

  5. 05

    On the day

    Admission, block and surgery

    Same-day admission, GA with an interscalene block. ORIF proximal humerus 90–150 min, clavicle plate 60–90 min, reverse arthroplasty for fracture 90–150 min. Sling on before you wake.

  6. 06

    On the day

    Recovery and discharge

    Clavicle plate: day-case or one night. Proximal humerus ORIF and reverse arthroplasty: one to two nights. Written protocol, sling weaned by physio not the surgeon.

  7. 07

    After

    Physiotherapy and radiographic review

    Sling for 2–4 weeks depending on the fracture and fixation. Physio 2–3 times weekly for 6–12 weeks. X-rays at 2, 6 and 12 weeks. Return to sedentary work at 2–4 weeks; heavy work 3–6 months.

Typical end-to-end: 7–14 days from first appointment to fixation. Full functional range: 3–6 months.

When it helps

The fracture patterns we see, and how each is best managed.

Proximal humerus, clavicle, scapula and greater tuberosity injuries - plus the one red flag that means A&E and the on-call trauma team, not a private booking.

  • Two-part proximal humerus fracture

    The commonest pattern in older women after a fall onto an outstretched hand. Most are minimally displaced and do beautifully in a sling for 3–4 weeks.

  • Displaced 3- or 4-part fracture (Neer)

    Three or four fragments with meaningful displacement or angulation - the group where PROFHER left room for judgement and where ORIF or reverse arthroplasty comes into play.

  • Middle-third clavicle fracture

    The classic collarbone break. Most heal in a broad-arm sling; plating is offered when the ends are shortened by more than 2 cm, comminuted, or in overhead athletes.

  • Greater tuberosity avulsion

    A bony piece pulled off the top of the humerus by the rotator cuff - usually after a dislocation. Anything displaced more than about 5 mm needs fixation.

  • Scapula and glenoid fracture

    High-energy injuries, often with rib or lung involvement. Most scapular body fractures are managed non-operatively; glenoid rim fractures with instability are fixed.

  • Head-splitting or dislocated fracture

    A humeral head split in two, or a fracture-dislocation that will not reduce closed - the classic indication for reverse shoulder arthroplasty in the older patient.

  • Non-union or malunion after conservative care

    A fracture that has failed to heal at 3–6 months, or has healed in a bad position - delayed fixation, osteotomy or arthroplasty is our second-opinion territory.

  • Red flag: open fracture, vascular or nerve injury

    Skin breach, cold pale hand, absent radial pulse, or new wrist and finger weakness need same-day A&E and the on-call trauma team, not a private appointment.

Procedure options

The pathway depends on the pattern and the patient.

What each option involves - from a sling for a 2-part proximal humerus through ORIF, nailing and reverse arthroplasty for the complex 4-part fracture.

  • Conservative sling management

    A broad-arm or collar-and-cuff sling for 2–4 weeks, then early physio. The default for undisplaced and most displaced 2-part proximal humerus fractures - the PROFHER trial territory.

  • ORIF with locking plate

    Deltopectoral approach, anatomically shaped locking plate for the proximal humerus or a superior/anteroinferior plate for the clavicle. The workhorse for displaced fixable patterns in good bone.

  • Intramedullary nail

    A less invasive alternative to plating for selected 2- and 3-part surgical neck fractures. Good for higher-BMI patients and where soft-tissue cover is a concern.

  • Reverse shoulder arthroplasty (RTSA)

    For head-splitting fractures, 4-part patterns in older patients, and where the tuberosities will not hold fixation. Predictable pain relief and elevation, at the cost of some rotation.

  • Hemiarthroplasty

    A partial replacement - now used far less often since reverse arthroplasty took over. Occasionally the right answer in younger patients with a preserved cuff.

  • Greater tuberosity fixation

    Screws, sutures or a small plate for a displaced tuberosity fragment - restores rotator cuff function and prevents impingement.

  • Clavicle plating

    A superior or anteroinferior locking plate for displaced middle-third fractures shortened more than 2 cm, comminuted, or in high-demand patients. Beats a sling in the right group.

  • Scapula and glenoid ORIF

    Reserved for glenoid rim fractures causing instability, floating shoulder injuries, or scapular neck fractures with severe angulation - a small-volume, sub-specialty operation.

Safety and recovery

What to expect afterwards - honestly.

Shoulder trauma surgery is well-established, but proximal humerus fixation carries real screw cut-out and avascular necrosis risks that the PROFHER data made impossible to ignore. We plan for stiffness, not against it.

  • GA with interscalene block

    Standard for all shoulder trauma surgery - 12–18 hours of pain control lets you get out of bed and start finger and elbow movement the same day.

  • PROFHER - surgery is not always better

    The UK PROFHER trial showed no difference in patient-rated outcomes at 2 years between ORIF and sling for most displaced proximal humerus fractures. We share the data before booking theatre.

  • Screw cut-out and avascular necrosis

    After ORIF of the proximal humerus, screw cut-out through the head occurs in 5–15 percent, and avascular necrosis in 3–10 percent depending on pattern and bone quality. Locking plates and calcar screws reduce but do not abolish the risk.

  • Non-union and malunion

    Clavicle non-union sits around 1–3 percent after plating and up to 15 percent after sling management of significantly displaced fractures. Proximal humerus non-union under 5 percent.

  • Infection, DVT and PE

    Deep infection under 1 percent for clean shoulder trauma work. DVT prophylaxis and early mobilisation are routine. Call the same day for spreading redness, fever, calf pain or breathlessness.

  • Nerve injury

    Axillary nerve neurapraxia is the classic risk with proximal humerus surgery. Deltoid numbness is common and usually recovers; permanent weakness is rare.

  • Stiffness is the commonest outcome

    Whether treated in a sling or with fixation, some loss of overhead reach is common. Sticking to the physio protocol in weeks 2–12 is the single biggest factor in the final range.

  • Reverse arthroplasty for fracture

    For the elderly patient with a 4-part or head-splitting fracture, reverse arthroplasty gives predictable pain relief and elevation. Rotation is often modest and the prosthesis is not designed for heavy overhead work.

  • Red flags after surgery

    Fever, spreading redness, calf pain, breathlessness, cold pale hand, or new wrist and finger weakness need the same-day team or A&E, not a routine call.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whether the surgeon fixed the fracture with a plate, a nail, or replaced the joint, the note keeps to the same shape.

A UK consultant upper-limb surgeon reviewing a patient's post-op X-rays

A quiet reminder

The Impression section is where the sling and physio plan lives - read it first.

If you would like us to talk you through the operation note before your first physio session, just ask.

  1. 01 Header

    Fracture pattern, side and Neer classification

    Which bone, which side, and how the pieces are described - Neer 2, 3 or 4-part for the proximal humerus, and Robinson or AO for the clavicle.

  2. 02 Technique

    Approach, fixation and implants

    Deltopectoral or deltoid-splitting for the humerus; superior or anteroinferior for the clavicle. Plate and screw configuration, or the arthroplasty components and size used.

  3. 03 Findings

    Reduction, cuff and bone quality

    How well the fragments came together, whether the tuberosities were secured, the state of the rotator cuff, and whether the bone was osteoporotic - all of which shape the physio pace.

  4. 04 Impression

    Sling, physio and follow-up plan

    Read this first: how long the sling stays on, when active movement begins, when overhead work is permitted, and the X-ray follow-up schedule.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Fracture fixation and reverse arthroplasty are usually covered where the injury has been documented. Second opinions on an NHS plan are widely reimbursed.

Frequently asked

Everything we get asked about shoulder fracture treatment.

Quick answers on PROFHER, sling versus surgery, reverse arthroplasty and cost.

  • Is shoulder fracture treatment normally NHS or private?

    Acute shoulder trauma is almost always NHS - go straight to A&E. Where private care fits is in a second opinion on the A&E plan, elective delayed fixation of a fracture that has drifted or failed to heal, and structured private physiotherapy alongside NHS follow-up. Reverse arthroplasty for a 4-part fracture is done in both settings; the surgeon’s volume matters more than the badge on the door.

  • Do I really need surgery for a proximal humerus fracture?

    For most displaced 2-part fractures in older patients, the UK PROFHER trial found no meaningful advantage from surgery at two years - a sling for 2–4 weeks then physio gives comparable results at lower risk. Surgery earns its place for head-splitting patterns, dislocated fractures, 3- and 4-part patterns in active patients, greater tuberosity avulsions with more than about 5 mm of displacement, and cases where the cuff and calcar are compromised.

  • When is a reverse shoulder replacement chosen over ORIF for a fracture?

    When the head is split, the tuberosities will not hold fixation, or the patient is older with poor bone - reverse arthroplasty gives predictable pain relief and forward elevation without relying on the rotator cuff. ORIF is preferred in younger patients where fixation is likely to hold, because reverse replacements are not designed for a lifetime of heavy overhead loading.

  • How is a clavicle fracture treated in 2026?

    Most middle-third clavicle fractures still heal well in a broad-arm sling over 6–12 weeks. Plating is offered when the fragments are shortened by more than 2 cm, when the fracture is comminuted, when the skin is threatened, and for overhead athletes, throwers and manual workers where union rate and time to return to sport matter. Non-union after conservative care sits around 15 percent in significantly displaced fractures, versus 1–3 percent after plating.

  • What imaging is needed for a shoulder fracture?

    Plain X-rays - AP and axillary or Y views - classify most clavicle, scapular and simple proximal humerus fractures. Displaced 3- and 4-part proximal humerus patterns, glenoid rim fractures, and any pattern being considered for surgery get a CT with 3D reconstruction to plan fixation or arthroplasty properly. MRI is reserved for suspected cuff or labral injury alongside the fracture.

  • How much does private shoulder fracture treatment cost in the UK?

    A conservative pathway with sling, physio and follow-up X-rays runs £600–£1,500. ORIF of a proximal humerus is £8,000–£14,000, a clavicle plate £5,500–£9,000, and a reverse shoulder arthroplasty for fracture £16,000–£24,000. A second-opinion consultation is £250–£450 and CT with 3D reconstruction £450–£850.

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