What is the treatment for a displaced fracture of the head of the humerus?

Treatment of Displaced Fracture of the Head of Humerus

For displaced fractures of the humeral head in adults, open reduction and internal fixation (ORIF) with anatomical reduction and rigid fixation is the recommended treatment to achieve optimal functional outcomes and reduce complications. 1

Treatment Algorithm

Initial Assessment

• Radiographic evaluation to determine fracture pattern and displacement
• CT scan for better delineation of fracture patterns and humeral neck angulation 2
• Assessment of neurovascular status, particularly in cases with vascular compromise

Treatment Options Based on Patient Factors

For Adults

1. Primary Treatment: Open Reduction and Internal Fixation

   • Posterior approach with plating is recommended by the American Academy of Orthopaedic Surgeons 1
   • Surgery should be performed within 5 days of injury to minimize complications 3
   • Anatomical reduction with rigid fixation allows for immediate postoperative movement 1

2. Surgical Technique

   • Posterior midline incision centered over the olecranon
   • Triceps-splitting approach or olecranon osteotomy for exposure
   • Use of contoured plates (posterior or dual plate configuration) 1

3. For Severely Comminuted Fractures or Elderly Patients

   • Consider hemiarthroplasty when anatomic reduction cannot be achieved

For Pediatric Patients

• Different approach required (closed reduction with pin fixation) for pediatric supracondylar fractures 2

Postoperative Management

• Early controlled mobilization as soon as pain allows 1
• Remove posterior splint within 1-2 weeks
• Initiate physical therapy for range of motion exercises
• Early mobilization is crucial for preventing stiffness 1

Timing Considerations

• Surgery should be performed within 5 days of fracture event 3
• For head split and dislocated fracture types, reconstruction within 48 hours may be beneficial to reduce risk of avascular necrosis 3
• Delaying intervention beyond 5 days significantly increases complication rates (odds ratio 1.637) 3

Potential Complications

• Loss of fixation (12.8% of cases) 3
• Screw cutout (4.9%) 3
• Avascular head necrosis (6.8%) 3
• Ulnar nerve injury, triceps weakness, elbow stiffness, hardware prominence, and infection 1

Special Considerations

• For minimally displaced fractures, conservative management with early mobilization may be sufficient 4
• In complex cases with vascular compromise, emergent reduction is indicated 2
• For fractures with proximal extension into the metadiaphyseal region, fixation must extend proximally into the humeral head and neck 5

The treatment of displaced humeral head fractures requires careful preoperative planning and meticulous surgical technique. The timing of surgery is critical, with evidence showing that intervention within 5 days of injury provides the best outcomes and lowest complication rates.