Displaced fractures in an older patient with lower demands can be treated with conservative methods. In such cases the patient would even accept higher angulation and if the shoulder is well rehabilitated, the motion of shoulder joint would compensate most of the movements hampered by angulation.
However in young, active patients with higher demands, a surgical procedure would be necessary.
Closed Reduction
The arm is adducted and is flexed 90 degrees. This maneuver relaxes Pectoralis muscle.. A translation force (usually posteriorly and laterally) is applied to reduce the deformity while longitudinal traction is applied. After it is felt that reduction has been achieved a gentle reimpaction is tried.
After the fracture has been reduced immobilization is continued for 4 weeks.
If the fracture is reducible but unstable, percutaneous pins after closed reduction might be used. If a reduction cannot be achieved, open reduction and internal fixation are considered.
Rehabilitation After Surgery
If fixation is good and fracture is stable, early passive range of motion is instituted, including pulley elevation in the scapula plane, external rotation with a stick, pendulum, and hand and elbow range of motion. Progression to full stretches is rapid. Strengthening is added at 6 weeks.
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