Operative treatment of displaced surgical neck of humerus fractures

Surgical neck fractures are the most common type of proximal humerus fractures. Surgical neck fractures occur in all age groups, affecting pediatric, young adult, and geriatric individuals. The majority of surgical neck of the proximal humerus fractures are nondisplaced or minimally displaced and do not require operative intervention. Displaced fractures can disrupt the function of the upper extremity, however, and often necessitate operative care. Standard radiographs should include an anteroposterior view taken in the scapular plane, a scapular "Y" lateral, and an axillary view. If the patient is in too much discomfort to obtain a standard axillary view, a Velpeau axillary can be obtained. Nondisplaced fractures, greater tuberosity fractures with less than 5-mm displacement, and surgical neck fractures with less than 1-cm displacement and 45° angulation should be treated by nonoperative means. The reduction maneuver involves longitudinal traction on the arm to disimpact the fracture. The arm is abducted approximately 70°, and then a posterior force is applied to the shaft of the humerus to correct the apex anterior angulation. Slight external rotation of the shaft may be necessary. The fracture can then be impacted for increased stability. Displaced surgical neck fractures can be stabilized by a variety of techniques. Some of the commonly used techniques involve percutaneous pin fixation, suture techniques, antegrade and retrograde insertion intramedullary rods, a combination of Ender nails and suture techniques, plate and screw fixation, and external fixation. In this article, we will discuss the use of these techniques, the details of percutaneous pinning, and the technique of Ender nail and suture fixation.