MANUAL MINORS
Fractures of the neck and head of the humerus are common shoulder injuries, particularly in older individuals with osteoporosis or in people who experience falls onto an outstretched arm.
These fractures can involve the anatomical neck, surgical neck, or humeral head. Depending on the severity and displacement of the bone fragments, the fractures may be stable or unstable, and they are often classified using the Neer classification system.
Diagnosis
The diagnosis is based on a history of trauma, such as a fall, followed by acute pain, swelling, deformity, and difficulty or inability to move the arm. Anteroposterior, lateral, and axillary X-rays of the shoulder confirm the fracture and help classify it according to the number of fragments and degree of displacement. In complex fractures, a computed tomography (CT) scan can provide a more precise assessment of joint damage and guide surgical treatment.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Anterior shoulder dislocation | Visible deformity, loss of joint alignment, and difficulty moving the shoulder |
Clavicle fracture | Pain and deformity over the clavicle, common after falls onto the shoulder |
Rotator cuff tear | Weakness and chronic shoulder pain without fracture evidence on X-rays |
Bicipital tendinitis | Pain in the front of the shoulder, without fracture signs |
Shoulder osteoarthritis | Chronic pain with limited mobility, visible on X-rays with degenerative changes |
Emergency Management
Initial emergency management includes immobilising the affected arm with a sling or splint in a neutral position to relieve pain and prevent movement. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered for pain control.
In cases of displaced fractures or severe instability, urgent surgical reduction may be required. It is essential to assess neurovascular function in the arm, as these fractures can compromise the axillary nerve and blood vessels.
Definitive Treatment
Treatment depends on the type and severity of the fracture, according to the Neer classification. Non-displaced fractures are treated conservatively with immobilisation for 3 to 6 weeks, followed by physiotherapy to restore the range of motion. Displaced fractures, especially those involving the humeral head, may require open reduction and internal fixation with plates and screws.
In severe cases, such as comminuted fractures or fractures in older patients, partial or total shoulder replacement (arthroplasty) may be necessary. Rehabilitation is crucial to regain functionality and prevent stiffness or limited mobility.
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