Initial Treatment for Non-Displaced Humeral Neck Fracture
For a non-displaced fracture of the humeral neck, immobilize with a posterior splint (back-slab) rather than a simple sling, as this provides superior pain relief in the first two weeks while allowing the fracture to heal non-operatively. 1
Immobilization Method
Use a posterior splint/back-slab immobilization for the first 3 weeks, as this has been demonstrated in randomized controlled trials to provide significantly better pain control compared to collar-and-cuff or simple sling immobilization during the critical early healing period 1
The evidence supporting posterior splinting comes from moderate-quality Level II studies including a randomized controlled trial of 50 patients that directly compared immobilization methods 1
Non-Operative Treatment Rationale
Most non-displaced proximal humeral fractures achieve excellent functional outcomes with conservative management, with 94% satisfactory results reported for undisplaced fractures 2
Non-operative treatment avoids surgical complications including infection, hardware failure, and neurovascular injury while achieving comparable long-term functional scores to operative management 3
In adults over 50 years, the EULAR/EFORT guidelines confirm that most proximal humeral fractures can be treated non-operatively with good functional outcomes 1
Rehabilitation Protocol
Immobilize for 3 weeks in the posterior splint, then begin a staged rehabilitation program 4
Weeks 3-6: Begin pendular and active-assisted exercises to prevent capsular contracture of the glenohumeral joint 5, 4
After 6 weeks: Progress to active range of motion exercises 4
Early mobilization within pain limits is critical - prolonged immobilization beyond 3 weeks increases the risk of joint capsule contracture and requires longer physiotherapy courses 2
Important Caveats
Assess neurovascular status carefully at presentation, as humeral neck fractures can compromise limb perfusion even when non-displaced 1
Set realistic expectations: Full recovery typically takes an average of 8 months, though patients show continuous improvement throughout this period 4
Age affects outcome more than treatment timing - older patients may have slower functional recovery regardless of when therapy begins 5
Monitor for displacement: Serial radiographs during the first 2-3 weeks ensure the fracture remains stable and non-displaced 2