In some cases it is beneficial to perform a closed reduction and closed osteosynthesis. This induces no further damage to the soft-tissue and does not disturb the fracture zone including the fracture hematoma. It also does not disturb the subacromial space and allows prolonged immobilization postoperatively in a shoulder immobilizer.

The overall stability of cannulated screws alone is limited and 2-3 weeks postoperative immobilization in a shoulder immobilizer is recommended.

Danger zone around the axillary nerve enlarge

Risk of axillary nerve injury

The main structure at risk is the axillary nerve. The axillary nerve should be protected by limiting the incision to less than 5 cm distal to the acromial edge, by palpating the nerve, and by avoiding maneuvers that stretch the nerve during reduction and fixation. Remember the course of the nerve when placing K-wires.