Impacted minimally displaced proximal humerus fractures, even though they involve the anatomical neck, have a relatively good prognosis. Due to the intact periosteum, they are often quite stable. Improved alignment can often be obtained, and stability provided with minimal fixation (eg, screws alone). This technique requires caution if there is osteoporosis or comminution.
Reduction with disimpaction may result in fracture instability. Some of these fractures may have questionable stability before reduction. To improve stability, an osteosynthesis might be considered.
Valgus impacted 3- and 4-part fractures and slightly displaced comminuted fractures with varus malalignment are particularly suitable for less invasive reduction and fixation. These are the most suitable procedures for patients with good bone quality.
Because fractures with varus deformity are less stable use caution when choosing screws alone for fixation.
Risk of avascular necrosis
Even minimally displaced anatomic neck fractures have a significant risk of avascular necrosis (AVN) of the humeral head. This risk is increased with extensive surgical exposure for open reduction and plate fixation.
With the blood supply already at risk, closed reduction and minimal internal fixation through very limited approaches is advisable.