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Surgical neck with translation or multifragmentary: Principles

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

For fractures with medial hinge disruption or medial fragmentation, reduce a medially displaced fracture by pulling the humeral shaft to the plate by tightening an initial bicortical non-locking screw in the humeral shaft.

Proper reduction
Achieving proper reduction may be very demanding due to the characteristic metaphyseal instability of these fractures. Multifragmentary fractures may be reduced appropriately by using the laterally applied plate as a model for an appropriate reduction. The plate is first attached distally and then brought into contact with the fragmentary zone and proximal segment, to which it is affixed. Once initially stabilized, confirm satisfactory reduction before insertion of all the planned screws.

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.