What is the treatment for a humerus neck fracture using a sling?

From the Guidelines

A sling is an appropriate treatment for stable, non-displaced surgical neck fractures of the humerus, and I recommend using a simple arm sling for immobilization for approximately 2-3 weeks, followed by gentle pendulum exercises and progressive range of motion as pain allows. For this injury, the goal is to minimize discomfort while allowing the fracture to heal, and a sling can provide the necessary support and immobilization 1. The treatment approach should prioritize minimizing morbidity, mortality, and optimizing quality of life, which in this case, involves a conservative management strategy.

Key Considerations

• The sling should be worn continuously except during bathing and prescribed exercises to ensure consistent immobilization and support.
• Pain management is crucial and can typically include acetaminophen 650-1000mg every 6 hours as needed, possibly supplemented with NSAIDs like ibuprofen 400-600mg every 6-8 hours if not contraindicated.
• Ice can be applied for 15-20 minutes several times daily during the first few days to reduce swelling and pain.
• Physical therapy should begin around 3-4 weeks post-injury to restore shoulder function and prevent stiffness, focusing on range-of-motion exercises including shoulder, elbow, wrist, and hand motion 1.

Important Notes

• The decision to use a sling for a humerus neck fracture is based on the fracture being stable and non-displaced. If the fracture is displaced more than 1cm, angulated more than 45 degrees, or involves multiple fragments, surgical intervention may be necessary instead.
• Regular follow-up with orthopedics at 1-2 weeks and then 4-6 weeks with X-rays is essential to ensure proper healing and alignment.
• Above chest level activities should be restricted until fracture healing is evident to prevent complications and promote optimal recovery 1.

From the Research

Treatment for Humerus Neck Fracture Using a Sling

• The treatment for a humerus neck fracture using a sling is a form of non-surgical treatment, also known as conservative treatment 2, 3.
• This type of treatment involves the use of a sling to immobilize the arm and allow the fracture to heal on its own 2, 3.
• Studies have shown that non-surgical treatment can be effective for certain types of proximal humeral fractures, including two-part surgical neck fractures 4.
• A study published in the Journal of the American Medical Association (JAMA) found that there was no significant difference in patient-reported clinical outcomes between surgical and non-surgical treatment for displaced proximal humeral fractures involving the surgical neck 2.
• Another study published in The Cochrane Database of Systematic Reviews found that there was high-quality evidence of no clinically important difference in patient-reported shoulder and upper-limb function at one- or two-year follow-up between surgical and non-surgical treatment for displaced proximal humeral fractures involving the humeral neck 3.
• However, some studies have suggested that operative treatment may result in better range of motion and reduced pain in the early postoperative course of treatment for two-part fractures of the proximal humerus 4, 5, 6.

Comparison with Other Treatments

• Studies have compared the outcomes of non-surgical treatment with other treatments, such as locking plate fixation and intramedullary nailing, for proximal humeral fractures 5, 6.
• A study published in the Journal of Orthopaedic Trauma found that there were no significant differences in pain, function, or range of motion between patients who underwent locking plate fixation and those who underwent intramedullary nailing for displaced surgical neck fractures of the humerus 6.
• Another study published in BMC Musculoskeletal Disorders found that cement-augmented locking plate fixation and multiplanar angle stable locking nail fixation were both effective treatments for 2-part surgical neck fractures of the proximal humerus in elderly patients 5.

Outcome Measures

• Outcome measures for the treatment of humerus neck fractures using a sling include pain, range of motion, and functional scores, such as the Oxford Shoulder Score, the Short-Form 12 (SF-12), and the Disabilities of the Shoulder, Arm and Hand Score (DASH) 2, 3, 5.
• Studies have used these outcome measures to compare the effectiveness of different treatments for proximal humeral fractures, including non-surgical treatment, locking plate fixation, and intramedullary nailing 2, 3, 5, 6.