Displaced, non-impacted surgical neck fractures may have some comminution. Only the non-comminuted fractures are suitable for closed screw fixation. Because these fractures have little intrinsic stability, screws alone should be used with caution. Plate or nail fixation may be more stable.
After reduction, alignment should be correct in both sagittal and coronal planes. Rotational alignment must also be correct.
A nearly anatomical reduction is necessary for successful fixation. Proceed to open reduction if closed techniques do not succeed.
Risk of axillary nerve injury
The main structure at risk is the axillary nerve. The axillary nerve should be protected by avoiding incisions within the region of this nerve. It lies approximately 6 cm below the lateral edge of the acromion. Avoid placing wire or screws through a 2 cm wide zone beginning 5 cm below the acromion.