Surgical Neck Fractures of the Humerus
- See:
-
Fracture Dislocations of the Proximal Humerus
:
-
Two Part Fractures
:
- Discussion:
- most common fracture of
proximal humerus
;
- frx is extracapsular, usually has an adequate blood supply and relatively low incidence of AVN;
- in contrast, anatomic neck frx has much higher incidence of AVN;
- upper fragment is usually abducted & externally rotated by muscles inserting onto greater tubercle, while lower fragment is adducted & internally rotated by
internal rotators;
-
stable vs unstable fractures:
- surgical neck fractures should be classified as either stable or unstable;
- unstable fractures may result from either low or high velocity forces;
- compression frxs tend to be stable,
- shear injuries tend to be unstable;
- periosteal tissue disruption leads to inscreased frx instability;
- unstable frx will display gross motion between shaft & head fragments;
- associated tuberosity frx:
- associate undisplaced frx into tuberosities are common, but they do alter natural history because the soft tissues are retained;
- Radiographs:
- eventhough the patient’s arm will be tender to abduction, the
axillary view
often is the most important view (since it tends to show the most displacement);

- Non Operative Treatment:
- determination of stability:
- stability is present when the patient can actively move extremity w/o pain, & limb can be moved passively w/ little pain & no abnormal motion between fragments;
- flouroscopic exam may indicate lack of motion between shaft & prox fragment, implying intact soft tissue envelope and a stable frx;
- impacted stable fracture in which the shaft and head move as one unit;
- arm may be immobilized in a sling & early motion started immediately;
-
reduction of surgical neck fractures
:
- humeral shaft is usually displaced medially (by pull of pectoralis) & anteriorly by pectoralis;
- w/ a 2 part frx, both tuberosities are attached to humeral head along w/ intact rotator cuff allowing humeral head to remain in a neutral position;
- posterior periosteal hinge is frequently present and contributes to apex anterior angulation of the proximal shaft;
- left uncorrected, decr of forward elevation may comprimise f(x);
- immobilization is required until sufficient frx healing allows pt pain free motion, which may take from 2-6 weeks;
- severe pain & delayed union will require prolonged immobilization, which may lead to permanent stiffness;
- generally immbolization for more than 2 weeks will lead to shoulder stiffness;
- non im
المزيد
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