1 Treatment guidelines top
enlarge
Slight to moderate displacement of proximal humerus fractures may be treated by external support alone. A broad arm sling is the commonest method. A triangular bandage is wrapped around the elbow and the forearm (knot is tied behind the neck), so that disimpaction is less likely. This is preferred in fractures with valgus angulation, in which disimpaction or gravitational correction is not desirable.
2 Reduction top
Reduction is not required in this method.
3 Fixation with Velpeau bandage top
enlarge
As an extra protection against rotational stresses, a Velpeau type of body bandage should be added, which can be worn under the clothes.
4 Pitfall - shoulder stiffness top
enlarge
The potential problem of skin maceration can be prevented by the Velpeau bandage mentioned.
Prolonged immobilization may give rise to shoulder stiffness, and therefore
the body bandage should be discarded after the initial two weeks. Retaining the
sling only, pendular exercises may be started once acute pain subsides.
At four weeks, gentle active exercises can be started, and the patient should
be encouraged to discard the sling in gradual stages over the next two weeks,
after which more active physiotherapy should be started (with stabilization of
the scapula).