Impacted surgical neck fractures without comminution, if the fracture plane is oblique and long enough, may often be fixed satisfactorily with lag screws after closed reduction.

Disimpaction is the key to successful reduction.

Proper reduction
After reduction, alignment should be correct in both sagittal and coronal planes. Rotational alignment must also be correct.

The axillary nerve should be protected by avoiding incisions within the region of this 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.