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Simple surgical neck with angulation: Principles

Reduction technique
For unimpacted surgical neck fractures generally, the most appropriate reduction technique will depend upon the fracture morphology.
Medial hinge intact:

  • Fix plate to the humeral head and use it as reduction aid
  • Reduce and fix the shaft to the plate

Proper reduction
After reduction, both, the sagittal and the coronal plane should be correct. Particular attention should be paid to the correct rotation.

Particularly with comminuted surgical neck fractures, remember that rotator cuff sutures can help reduce the humeral head against the plate to restore normal alignment.

Choose whichever approach is best suited for anticipated reduction maneuvers. The deltopectoral approach, while more extensile, is more invasive, but may provide easier access to a longer plate.

Correct plate position
A correct plate position must be ensured in order to avoid loss of reduction and impingement.