The surgical neck of the humerus is located 2-3 cm below the anatomical neck, at the junction between the cancellous bone of the humeral head and the cortical bone of the humeral shaft, making it highly susceptible to fractures. These fractures can occur at any age, but are more common in the elderly.

bubble_chart Etiology

1. Smaller direct violence can cause fissured fractures; if the palm touches the ground during a fall, smaller indirect violence transmitted upward can form a non-displaced impacted fracture.

2. Abduction-type fracture

When falling with the upper limb abducted and the palm landing on the ground, indirect violence transmitted upward causes the fracture. The proximal end of the fracture adducts, and the distal end abducts, forming an angular deformity or overlapping deformity forward and inward. This is more common clinically.

3. Adduction-type fracture

In contrast to the abduction-type fracture, when falling with the hand or elbow landing on the ground and the upper limb adducted, the proximal end of the fracture abducts, and the distal end adducts, forming an outward angular deformity. This is less common.

bubble_chart Clinical Manifestations

Shoulder swelling is often accompanied by static blood spots on the front and inner sides. When there is a fracture with displacement, the upper arm is slightly shorter than the healthy side, and there may be abduction or adduction deformity. There is obvious tenderness at the lower part of the greater tuberosity fracture, and shoulder joint movement is limited. If the fracture ends are impacted, the shoulder joint can be moved under protection. Pay attention to differentiate from shoulder dislocation. If combined with brachial plexus, axillary artery and vein, and axillary nerve injury, corresponding signs may appear.

A history of falling with the hand or elbow landing on the ground or direct violence to the shoulder, accompanied by shoulder pain that worsens with movement. X-rays can confirm the diagnosis and show the type of fracture and the degree of displacement.

bubble_chart Treatment Measures

1. Non-displaced fracture

For linear or impacted non-displaced fractures, use a triangular bandage to suspend the affected limb for 3 weeks, and perform early functional exercises.

2. Abduction-type fracture

For grade I deformity or impaction and elderly or frail patients, reduction is not required. Place a cotton pad under the armpit and fix the affected limb to the chest for 3 weeks, followed by shoulder joint swinging exercises. For significant deformity or obvious displacement, manual reduction and chest fixation are required, with shoulder and elbow joint exercises after 4 weeks.

3. Adduction-type fracture

The treatment principle is the same as for abduction-type fractures, with antagonistic reduction techniques. When fixing to the chest, place more cotton pads on the lateral side of the upper arm at the fracture plane. If alignment cannot be maintained, a shoulder spica cast can be used for 4 weeks.

4. Surgical treatment

For fractures with soft tissue interposition or fractures combined with shoulder dislocation, where manual reduction or external fixation fails; or for cases treated late where manual reduction is no longer possible, especially in young and middle-aged patients, open reduction can be performed, and internal fixation such as plate screws, lag screws, or Kirschner wires can be appropriately selected based on the situation.

bubble_chart Differentiation

AD

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1. Surgical cervical vertebra fracture

Shoulder contour - normal

Chest approximation test - negative

Position of humeral head - normal

2. Shoulder dislocation:

Shoulder contour - square shoulder

Chest approximation test - positive

Position of humeral head - displaced