[Closed treatment of fractures of the humeral head. Indications, technique, limits]

Abstract

Beginning with the specific mechanism of injury and characteristic physical and radiographic signs, the different forms of conservative treatment of fractures of the upper humerus are presented. As a result of biomechanical principles, the forces that generate the fracture cause dislocations of the fragments, and these dislocations follow basic rules. A fracture is considered dislocated if any of the fragments are displaced over 1 cm or if the angulation is more than 45 degrees. In dislocated fractures of the proximal humerus, reduction is indicated. The technique is presented in detail for the different types of fractures. Minimally displaced fractures or those that may be reduced by closed methods and do not redislocate are usually managed by conservative treatment. The affected shoulder is immobilized as a rule in a Gilchrist sling for 1-2 weeks. Functional exercises begin as soon as false motion of the fracture can be excluded by careful examination. In order to achieve optimal functional recovery, the exercises should be continued for longer than the bone union; that can be expected at 6-8 weeks. The special features and limitations of conservative treatment are discussed in relation to the different types of fractures.