Humeral Surgical Neck Fracture

A 32-year-old man sustained a humeral neck fracture from a fall. A proximal humerus fracture often results from a fall on an outstretched hand is called a “FOOSH” injury.

Thomas A. Keel, MS, OPA, of San Antonio, Tex, reports that these injuries are not common in young people but are increasingly occurring in older persons, particularly women. Humeral head fractures, like posterior shoulder dislocations, are frequently missed.^1,2 Neer's four-part classification system, which is based on segment displacement and angulation of the head, shaft, and greater and lesser tuberosities in the proximal humerus, is helpful in diagnosing proximal humeral fractures.³

The radiographs show the surgical neck fracture (A); a transthoracic view clearly demonstrates the humeral head displacement (B). In addition to these views, true axillary glenohumeral radiographs may be useful.

Proximal humeral fractures can present as minimally displaced or severely displaced, with the threat of avascular necrosis.

Carefully evaluate the injured shoulder girdle to avoid missing a proximal humeral fracture.

This patient underwent open reduction and internal fixation of the humeral fracture followed by rehabilitation. The injury has healed with no sequelae.

REFERENCES:1. Rockwood CA, Green DP. Rockwood and Green's Fractures in Adults. 4th ed. Philadelphia: Lippincott-Raven Publishers; 1996.
2. Rockwood CA, Matsen FA. The Shoulder. 2nd ed. Philadelphia: WB Saunders; 1998.
3. Iannotti JP, Williams GR Jr. Disorders of the Shoulder: Diagnosis and Management. Philadelphia: Lippincott, Williams & Wilkins; 1999.