From the Research
Management of a displaced humeral surgical neck fracture typically requires surgical intervention, most commonly open reduction and internal fixation (ORIF) with plates and screws or intramedullary nailing, as seen in the study by 1, which reported excellent clinical outcomes and a low rate of complications with the use of third-generation percutaneous intramedullary nailing.
Preoperative Management
Preoperatively, the arm should be immobilized in a sling, with adequate pain control using NSAIDs like ibuprofen (400-600mg every 6 hours) or naproxen (500mg twice daily), combined with acetaminophen (1000mg every 6 hours) and, if needed, short-term opioids such as hydrocodone/acetaminophen 5/325mg every 4-6 hours.
Surgical Intervention
Surgical fixation is generally preferred for displaced fractures because it allows for anatomic reduction, stable fixation, and earlier mobilization, which helps prevent stiffness and improves functional outcomes, as reported by 2 and 1. The choice of surgical technique, such as ORIF with plates and screws or intramedullary nailing, depends on the fracture pattern, patient factors, and surgeon preference.
Postoperative Management
Post-surgery, patients typically wear a sling for 4-6 weeks with early pendulum exercises starting around 2 weeks, followed by progressive range of motion exercises at 6 weeks and strengthening at 12 weeks. This rehabilitation protocol helps to improve functional outcomes and reduce the risk of complications, as seen in the study by 3.
Non-Operative Management
Non-operative management with sling immobilization may be considered for minimally displaced fractures or in patients with significant comorbidities that increase surgical risk. However, this approach may be associated with a higher risk of malunion, nonunion, or other complications, as reported by 4 and 5.
Key Considerations
- The use of third-generation percutaneous intramedullary nailing, as reported by 1, provides a high rate of fracture healing, excellent clinical outcome scores, and a low rate of complications.
- The choice of surgical technique and implant depends on the fracture pattern, patient factors, and surgeon preference.
- Early mobilization and rehabilitation are crucial to improve functional outcomes and reduce the risk of complications.
- Non-operative management may be considered for select patients, but it requires close monitoring and a high index of suspicion for potential complications.