From the Research
A stable surgical neck fracture of the humerus typically does not require surgical fixation. Conservative treatment with immobilization using a sling or brace for 2-6 weeks is usually sufficient for these fractures. During this period, limited pendulum exercises may begin after 1-2 weeks, followed by progressive range of motion exercises as pain allows. Full recovery generally takes 3-4 months. This approach is supported by the ProFHER trial 1, which found no statistically or clinically significant differences in outcomes between surgical and non-surgical treatment groups for displaced fractures of the proximal humerus involving the surgical neck.
Key Considerations
- The decision for conservative management is based on the bone's natural healing capacity in stable fractures and the risks associated with surgery, including infection, hardware problems, and anesthesia complications.
- Regular follow-up with X-rays every 1-2 weeks initially is important to ensure the fracture remains stable and is healing properly.
- Pain management typically includes acetaminophen or NSAIDs, with short-term opioids only if necessary for severe pain.
- Surgery becomes necessary only if the fracture is unstable, significantly displaced (>45 degrees angulation or >1 cm displacement), involves the articular surface, has multiple fragments, or if there is associated neurovascular injury.
Additional Evidence
While other studies have compared different surgical techniques for proximal humerus fractures, such as intramedullary nailing versus locking compression plate 2, the most recent and highest quality evidence supports conservative management for stable fractures 1.
Clinical Implications
In clinical practice, it is essential to prioritize a conservative approach for stable surgical neck fractures of the humerus, reserving surgery for cases with specific indications, such as instability or significant displacement. This approach can help minimize the risks associated with surgery and optimize patient outcomes.