Contents
Mechanism
- young: high energy trauma (MVA)
- older: fall on an outstretched hand (FOOSH) from standing height in osteoporotic individuals
Investigations
- x-rays: AP, trans-scapular, axillary are essential
- CT scan: in complex cases
Classification
- Neer classification is based on 4 fracture fragments: head, greater tuberosity, lesser tuberosity, shaft
- can be
-undisplaced: displacement <1 cm and/or angulation <45o
-displaced: displacement >1 cm and/or angulation >45o
-dislocated/subluxed: humeral head dislocated/subluxed from glenoid
 |
PEARL
Number of fragments are displaced according to their muscle insertions; greater tubercle abducted & ER while lesser tubercle is adducted & IR. |
Treatment
- non-operative
-sling immobilization (undisplaced): begin ROM when fracture is stable and moves as one unit (7-10 days)
-closed reduction (minimally displaced) - operative
-ORIF (displaced, dislocated); hemiarthroplasty may be necessary
Complications
- anatomic neck fractures disrupt blood supply to the humeral head and avascular necrosis (AVN) of the humeral head may ensue
- axillary nerve palsy, axillary nerve injury, non-union/malunion, shoulder stiffness (adhesive capsulitis), post-traumatic arthritis
