From the Guidelines
Most proximal humeral fractures, including mildly comminuted fractures of the surgical neck of the humerus, can be treated non-operatively with good functional outcomes. For patients older than 50 years, the management of such fractures should prioritize minimizing complications and promoting early mobilization to maintain quality of life and reduce morbidity and mortality 1.
Key Considerations
- Treatment of displaced fractures remains controversial, but for non-displaced or minimally displaced fractures, conservative management with a sling or shoulder immobilizer for 2-3 weeks is a reasonable approach.
- Pain management is crucial and can include acetaminophen or NSAIDs with appropriate gastric protection.
- Physical therapy should be initiated after 3-4 weeks to restore range of motion and strength, focusing on gentle exercises that do not compromise the fracture site.
- Regular follow-up with radiographs is essential to monitor healing progress and adjust the treatment plan as necessary.
Surgical Intervention
- For displaced fractures or when non-operative management is not feasible, surgical options such as open reduction and internal fixation (ORIF) or hemiarthroplasty may be considered, taking into account the patient's age, activity level, and overall health status 1.
- Reverse shoulder arthroplasty is another option, particularly in geriatric patients with pre-existing rotator cuff dysfunction or after the failure of first-line treatment, as it may provide satisfactory shoulder function 1.
Outcome Prioritization
- The primary goal in managing mildly comminuted fractures of the surgical neck of the humerus is to optimize functional outcomes while minimizing complications, thereby improving the patient's quality of life and reducing morbidity and mortality.
From the Research
Mildly Comminuted Fracture of the Surgical Neck of the Humerus
- A mildly comminuted fracture of the surgical neck of the humerus is a type of fracture that can be challenging to treat 2.
- The treatment of such fractures depends on various factors, including the degree of comminution, the patient's age, and the presence of any underlying medical conditions.
Treatment Options
- Surgical treatment is often necessary for displaced surgical neck fractures of the humerus, with options including percutaneous pinning, locking plates, and intramedullary nails 3.
- Locking plates and intramedullary nails have been shown to produce better results than percutaneous pinning, with higher Constant scores and better radiographic outcomes 3.
- Angularly-stable plate fixation and interlocking or reconstructive intramedullary nailing are also effective methods for stabilizing proximal humeral fractures, including comminuted fractures 2.
Outcomes
- The outcomes of treatment for mildly comminuted fractures of the surgical neck of the humerus can vary depending on the treatment method and the patient's individual characteristics 3.
- Studies have shown that patients treated with locking plates or intramedullary nails tend to have better functional outcomes and higher health-related quality of life scores than those treated with percutaneous pinning 3.
- However, the choice of treatment method should be individualized based on the patient's specific needs and circumstances, and the potential risks and benefits of each treatment option should be carefully considered 2, 3.