Management of surgical neck nonunions

A surgical neck nonunion is a seriously debilitating complication of a proximal humerus fracture. Patients have virtually no functional use of their shoulders and experience pain. Successful treatment is reliable in relief of pain and can potentially restore function. The diagnosis is not difficult to make on plain radiographs, but tuberosity or head-splitting fractures can be missed by plane films, and CT imaging may be necessary. Nerve injuries coexist in some cases and may be a significant factor in treatment decision making. Whether the fracture is treated with rods, plates, or prosthetic replacement, the surgical neck and associated tuberosity fractures need secure fixation. Careful mobilization of the rotator cuff and soft tissue balancing is imperative for optimal results. Postoperative care emphasizes early range-of-motion exercises to avoid stiffness. Strengthening exercises are added when appropriate. Successful treatment for these nonunions is difficult but gratifying because the percent improvement is immense.