ABSTRACT
Surgical neck fractures account for approximately 60-65% of all proximal humeral fractures in adults. Nearly 80% are minimally displaced and can be treated nonoperatively. Stable impacted, but severely angulated fractures (10% of all surgical neck fractures) with an intact posterior periosteal sleeve, as well as displaced surgical neck fractures with or without metaphyseal comminution (10% of all surgical neck fractures) are usually treated operatively in the absence of medical contraindications. Indeed, nonoperative management of displaced (unstable or impacted) fractures does not consistently lead to good clinical outcomes. In a recent series of 56 surgical neck fractures treated nonoperatively, Chun et al. reported that only 31 patients (55%) had an excellent or good result at a mean follow-up of 6.6 years (5). The mean forward flexion of the overall series was 1078. Another series reported 15% poor or unsatisfactory long-term results after nonoperatively treated surgical neck fractures (6). Deformity and stiffness due to immobilization are the most common negative sequelae of such treatment (6). Many different surgical procedures have been proposed to stabilize surgical neck fractures, including minimally invasive fixation such as percutaneous pinning (10-12), external fixation (14), plate fixation (9), or intramedullary stabilization (2,15).
