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Fractures of the head and anatomical neck of the shoulder: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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What causes a fracture of the head and anatomical neck of the humerus?
The mechanism of injury is direct - a blow to the outer surface of the shoulder joint, but it can also be indirect - when falling on the elbow joint of the abducted arm. The head of the humerus is crushed, and more often splits into several fragments. Sometimes the entire proximal epimetaphysis is subject to destruction.
Symptoms of a fracture of the head and anatomical neck of the humerus
Victims are concerned about pain and dysfunction in the shoulder joint.
Diagnosis of fracture of the head and anatomical neck of the humerus
Anamnesis
The anamnesis indicates a corresponding injury.
Inspection and physical examination
The shoulder joint is enlarged due to edema and hemarthrosis. Its contours are smoothed. Active movements are sharply limited, especially towards abduction. Passive movements are possible, but painful. Pressure on the head of the humerus causes pain. A positive symptom of axial load - pressure on the elbow joint from below upwards causes pain in the shoulder joint. A distinctive feature of supratubercular fractures is the absolute impossibility of active abduction of the shoulder (after anesthesia!), since the support on the articular surface of the scapula disappears.
Laboratory and instrumental studies
The diagnosis is confirmed by an X-ray of the shoulder joint, performed in two projections: direct and axial. Without an axial projection, it is impossible to accurately determine the presence of a fracture and the nature of the displacement of the fragments.
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What do need to examine?
Treatment of fracture of the head and anatomical neck of the humerus
Indications for hospitalization
Outpatient treatment of patients with impacted fractures of the anatomical neck and head of the humerus is permitted. In case of more complex injuries, patients are sent to the hospital.
First aid
Before transporting the victim to the hospital, painkillers are administered and transport immobilization is applied.
Conservative treatment of fracture of the head and anatomical neck of the humerus
Treatment of impacted fractures begins with a puncture of the shoulder joint and the introduction of 20 ml of a 1% procaine solution into its cavity. The limb is immobilized with a plaster cast according to Turner - from the healthy shoulder to the heads of the metacarpal bones. The arm is bent at the elbow, slightly tilted forward and abducted by 40-50 °. A wedge-shaped pillow is placed in the armpit to fill the space. Metamizole sodium is prescribed internally. UHF on the fracture area from the 3rd day and exercise therapy for the hand are also indicated.
On the 7th-10th day, the plaster cast is converted into a removable one, active movements in the wrist and elbow joints begin, passive ones - in the shoulder. After gymnastics and physiotherapy procedures (electrophoresis of procaine, then calcium and phosphorus preparations, ozokerite applications, etc.), the splint is put on again (it is finally removed after 3 weeks). The arm is suspended on a sling and rehabilitation treatment continues.
In case of fractures without displacement, even if they are multi-comminuted, a joint puncture is performed, hemarthrosis is eliminated and 20 ml of 1% procaine solution is administered. The limb is placed in a position with shoulder abduction to an angle of 45-50°, anterior deviation from the frontal axis of the body by 30° and fixed with a plaster thoracobrachial bandage or a CITO abduction splint.
In case of fractures with fragment displacement, it is necessary to perform repositioning under local anesthesia or, better, under general anesthesia. The essence of comparison consists of traction along the length in a functionally advantageous position with manual modeling of the fragments of the humeral head. After manipulation, the limb is fixed with a plaster thoracobrachial bandage or an abduction splint.
In case of comminuted fractures with slight displacement of fragments or in case of an unsuccessful attempt at closed manual reposition, the method of skeletal traction for the olecranon process on the CITO splint should be used.
The period of permanent immobilization for fractures with displacement of fragments is 6-8 weeks, removable - 2-3 weeks.
Surgical treatment of fracture of the head and anatomical neck of the humerus
Surgical treatment for intra-articular fractures of the proximal end of the humerus is indicated in the following cases:
- damage to the neurovascular bundle;
- open fracture, comminuted fracture, fracture-dislocation;
- interposition of soft tissues between fragments (most often this is the tendon of the long head of the biceps brachii);
- large comminuted fracture with displacement of fragments, when restoration of the anatomical shape of the bones is possible;
- failure of closed reduction.
The operation consists of open reposition and fixation of the fragments in one of the ways: with long screws or metal pins, inserted crosswise. In case of fractures along the line of the anatomical neck of the humerus, the head can be fixed with transosseous sutures or a Klimov beam.
After the intervention, the limb is fixed with a plaster thoracobrachial bandage for 6 weeks.