About This Procedure
Fractures of the shoulder and elbow region span a wide spectrum — from straightforward breaks that heal well with a sling to complex, multi-fragment injuries requiring precise surgical reconstruction. Choosing between operative and non-operative management is one of the most critical decisions in orthopedic trauma care, requiring careful assessment of the fracture pattern, patient age, bone quality, and functional goals.
Dr. Jay Levin provides expert surgical management of proximal humerus (shoulder) and elbow fractures for patients throughout Durham, Cary, and North Carolina. Trained by Rothman Orthopaedics and Duke Health Orthopaedics, he brings expertise in both fracture fixation and arthroplasty (joint replacement) — meaning he is equipped to perform the full range of operative solutions, from plate-and-screw fixation to shoulder or elbow replacement when reconstruction is not viable.
Many fractures are treated at Duke Health facilities in the Triangle, giving patients access to advanced imaging, anesthesia expertise, and integrated rehabilitation all within the same health system.
The Procedure
For fractures amenable to fixation, Dr. Levin performs open reduction and internal fixation (ORIF). This involves making a surgical incision to directly visualize the fracture, repositioning the bone fragments into their correct anatomic alignment, and securing them with plates, screws, or intramedullary nails. Intraoperative fluoroscopy guides accurate implant placement.
For severe proximal humerus fractures — particularly those with four or more fragments, poor bone quality, or compromised blood supply to the humeral head — shoulder replacement is the more reliable option. Reverse shoulder replacement is commonly used in these cases, as it does not depend on rotator cuff function and reliably restores comfortable arm elevation.
For elbow fractures, operative options include plate fixation (for distal humerus and olecranon fractures) and radial head replacement for comminuted radial head fractures. The choice is made based on fracture geometry and intraoperative findings.
Recovery at Duke Health
Recovery after fracture surgery begins earlier than most patients expect. Even while wearing a sling or splint, gentle motion exercises are initiated to minimize post-surgical stiffness — a common complication of shoulder and elbow injuries.
Sling or splint use typically continues for 2–6 weeks depending on fracture severity and fixation stability. Formal physical therapy with a Duke Health therapist begins within the first 2–3 weeks for most patients in Durham and Cary.
Full recovery — including regaining strength and range of motion — varies from 3 to 6 months depending on the complexity of the injury. Dr. Levin follows each patient closely throughout the healing process, using serial X-rays to confirm bone healing and guide rehabilitation progression.