From the Research
The recommended treatment for an impacted fracture of the humeral neck with probable comminution of the humeral head and calcification of the rotator cuff is surgical intervention, specifically reverse total shoulder arthroplasty (RTSA), as it provides early pain relief and return of shoulder function, particularly in patients ≥65 years old. Initial management should include immobilization with a sling, pain control with medications such as acetaminophen (1000mg every 6 hours) and/or NSAIDs like ibuprofen (400-600mg every 6-8 hours) if not contraindicated, and early orthopedic consultation 1. The surgical approach is preferred because the combination of comminution of the humeral head and calcification of the rotator cuff creates a complex injury pattern that often results in poor outcomes with conservative management.
Some key points to consider in the management of this condition include:
- The importance of early orthopedic consultation to determine the best course of treatment
- The use of RTSA as a preferred surgical approach, particularly in elderly patients with significant rotator cuff compromise 1
- The need for a structured rehabilitation protocol post-surgery, including passive range of motion exercises, active-assisted motion, and strengthening exercises
- The influence of age, activity level, bone quality, and extent of rotator cuff pathology on the specific surgical approach
It is also important to note that the treatment of impacted fractures of the humeral neck with probable comminution of the humeral head and calcification of the rotator cuff should prioritize minimizing morbidity, mortality, and optimizing quality of life. As such, the most recent and highest quality evidence should be considered, with RTSA being a viable option for patients who meet certain criteria, as outlined in the study by 1.
In terms of specific rehabilitation protocols, patients should follow a structured plan, beginning with passive range of motion exercises at 2-4 weeks, progressing to active-assisted motion at 6 weeks, and strengthening exercises at 12 weeks. Full recovery typically takes 6-12 months. Prompt treatment is essential to optimize functional outcomes and reduce complications such as avascular necrosis, malunion, and post-traumatic arthritis.