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Reduction of Surgical Neck Fractures

- Reduction of the Displaced Fracture:
    - if anterior angulation is > 45 deg, forward elevation will be limited;
    - gentle traction w/ flexion and some adduction is usually all that is needed to position arm in pivotal portion so that it can be impacted under head;
    - gental traction is placed on arm as it is brough out to side & then gently flexed;
    - traction should be maintained, and flexion is increased as the arm is gradually adducted to gain reduction of shaft beneath the head;
           - adduction neutralizes pull of pectoralis major & other internal rotators, which are creating the deformity;
    - impact proximal shaft beneath humeral head;
    - if reduction is not possible, there may be interposition of soft tissue, either muscle, capsule, or long head of biceps;
           - often long head of biceps is caught in frx site, creating tether that will distract frx w/ repeated attempts at reduction;
           - this situation requires ORIF