From the Research
The best conservative treatment for a fracture of the surgical neck of the humerus typically involves immobilization with a sling or shoulder immobilizer for 2-3 weeks, followed by early progressive rehabilitation. Initially, pain management includes acetaminophen (500-1000mg every 6 hours) and NSAIDs like ibuprofen (400-600mg every 6-8 hours) if not contraindicated, with short-term opioids such as hydrocodone/acetaminophen reserved for severe pain. After the initial immobilization period, gentle pendulum exercises should begin, progressing to active-assisted range of motion exercises at 3-4 weeks, and strengthening exercises at 6-8 weeks. Full recovery typically takes 3-4 months. This approach is effective because most surgical neck fractures are minimally displaced and stable, with good blood supply to promote healing, as shown in a study by 1. Conservative management avoids surgical risks while allowing the fracture to heal in an acceptable position. Regular follow-up with radiographs at 1,3, and 6 weeks is essential to ensure proper healing and alignment. Surgery may be considered if there is significant displacement (>45 degrees angulation or >1cm displacement), vascular compromise, or if the patient fails to progress with conservative treatment. Some studies, such as 2, have shown that early physiotherapy with a short period of immobilization is sufficient for the management of minimally displaced and/or impacted fractures of the proximal humerus. However, the most recent and highest quality study, 1, supports the use of conservative treatment for two-part fractures of the proximal humerus, with operative treatment resulting in a more effective reduction of pain at 3 months and a reduction of coronal plane malalignment. Key points to consider in conservative treatment include:
- Immobilization with a sling or shoulder immobilizer for 2-3 weeks
- Early progressive rehabilitation
- Pain management with acetaminophen and NSAIDs
- Gentle pendulum exercises progressing to active-assisted range of motion exercises and strengthening exercises
- Regular follow-up with radiographs to ensure proper healing and alignment.