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 prone to fractures. It can occur at any age but is more common in the elderly.

bubble_chart Etiology

1. Minor direct violence can cause fissured fractures; if the palm touches the ground during a fall, minor indirect violence transmitted upward can result in 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, while the distal end abducts, forming an angular deformity or overlapping displacement that is forward and inward. This type is more common clinically.
3. Adduction-type fracture: In contrast to the abduction-type fracture, it occurs when falling with the hand or elbow landing on the ground and the upper limb adducted. The proximal end of the fracture abducts, while the distal end adducts, forming an outward angular deformity. This type is less common.

bubble_chart Clinical Manifestations

In cases of shoulder swelling, static blood spots often appear on the front and inner sides. When there is displacement of the fracture, 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 site, and shoulder joint movement is limited. If the fracture ends are impacted, the shoulder joint can be moved under protection. It is important to differentiate from shoulder dislocation. If combined with brachial plexus, axillary artery and vein, or 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, resulting in shoulder pain that worsens with movement. X-rays can confirm the diagnosis and show the type of fracture and displacement.

bubble_chart Treatment Measures

1. Non-displaced fracture: For linear or impacted non-displaced fractures, suspend the affected limb with a triangular bandage for 3 weeks and initiate early functional exercises.
2. Abduction-type fracture: For grade I deformity or impacted fractures in elderly or frail patients, reduction is unnecessary. Place a cotton pad under the armpit and fix the affected limb against the chest for 3 weeks, followed by pendulum exercises of the shoulder joint. For severe deformity or obvious displacement, manual reduction and chest fixation are required, with shoulder and elbow joint exercises initiated after 4 weeks.
3. Adduction-type fracture: The treatment principle is the same as for abduction-type fractures, but the reduction technique is antagonistic. During chest fixation, more cotton pads should be placed on the lateral side of the upper arm at the fracture plane. If alignment cannot be maintained, a shoulder spica cast can be applied for 4 weeks.
4. Surgical treatment: Indicated for fractures with soft tissue interposition, fractures combined with shoulder dislocation, failed manual reduction or external fixation, or cases where manual reduction is no longer feasible due to delayed treatment, especially in young and middle-aged patients. Open reduction may be performed, with internal fixation such as plate screws, lag screws, or Kirschner wires selected as appropriate.

bubble_chart Differentiation

AD

TCM can effectively treat dry eye syndrome, floaters, retinopathy, and various chronic eye diseases

1. Surgical cervical vertebra fracture: Shoulder contour - normal
   Chest touch test - negative
   Position of humeral head - normal
2. Shoulder dislocation: Shoulder contour - square shoulder
   Chest touch test - positive
   Position of humeral head - displaced