Why a Humerus Neck Fracture is Called a Surgical Neck Fracture
A humerus neck fracture is called a "surgical neck" fracture because it occurs at an anatomically distinct region of the proximal humerus that frequently requires surgical intervention due to its high propensity for displacement and functional impairment.
Anatomical Explanation
The proximal humerus has several anatomically distinct "neck" regions:
- Anatomical neck: The groove immediately below the humeral head
- Surgical neck: The area just below the greater and lesser tubercles
- Morphological neck: The junction between the diaphysis and upper epiphysis
Key Differences
The surgical neck is clinically significant for several reasons:
- It represents a natural point of weakness in the bone structure 1
- It has a smaller circumference (mean 74.3-74.9 mm) compared to the anatomical neck (mean 128.9-131.4 mm) 1
- It's the most common location for proximal humeral fractures
Clinical Significance
The term "surgical neck" has practical implications:
- High fracture incidence: Fractures at this location are much more common than anatomical neck fractures 1
- Treatment considerations: While most proximal humeral fractures can be treated non-operatively, displaced surgical neck fractures often require surgical intervention 2
- Surgical approaches: When surgery is needed, specific techniques are employed for this region:
- Intramedullary nailing
- Locking plate fixation
- In severe cases, arthroplasty
Treatment Options
For surgical neck fractures of the humerus:
- Non-operative management is appropriate for most stable, non-displaced fractures 2
- Operative treatment is considered for:
- Displaced fractures with significant functional impairment
- Fractures with poor bone contact or stability
- Cases with high risk of nonunion
When surgery is required, options include:
- Intramedullary nailing: Less invasive approach with good outcomes 3
- Locking plate fixation: Provides stable fixation, especially in comminuted fractures 3
- Arthroplasty: For severe fractures or when nonunion has developed 4
Research shows that both intramedullary nailing and locking plate fixation yield similar outcomes in terms of pain relief and range of motion at 2-year follow-up 3.
Complications
Nonunion of surgical neck fractures can be particularly problematic:
- May require specialized surgical techniques such as impaling one fragment into another 5
- Often necessitates bone grafting to bridge the nonunion 5, 4
- Can lead to persistent pain and functional limitations if not properly addressed
Pitfalls to Avoid
- Misdiagnosis: Failing to recognize the difference between anatomical and surgical neck fractures
- Inappropriate fixation: Using fixation methods not suited for the specific fracture pattern
- Inadequate rehabilitation: Neglecting proper post-treatment rehabilitation can lead to stiffness and functional limitations
The term "surgical neck" is thus both an anatomical descriptor and a practical clinical term that helps guide treatment decisions for this common fracture location.