Shoulder Fractures

a. Proximal Humeral

What is a Proximal Humeral Fracture?
A proximal humeral fracture is a break in the upper part of the arm bone that forms the shoulder joint. The ball of the shoulder, or humeral head, is composed of four parts: the greater tuberosity, the lesser tuberosity, the anatomic neck and the surgical neck. In a proximal humerus fracture, one or more of these parts is detached.

What causes a Proximal Humeral Fracture?
Proximal humeral fractures are caused by trauma. Falls, motor vehicle accidents and shoulder dislocations are common causes.

What are the symptoms?
Patients with proximal humerus fractures have pain and swelling in the shoulder. They have difficulty lifting the arm, and usually have a bruise on the shoulder. Numbness in the shoulder area is a possibility. After a few days, swelling and bruising may extend down the entire arm into the hand and fingers. Patients will often experience clicking when they try to move their shoulder.

How is a Proximal Humerus fracture diagnosed?
Your surgeon will perform a physical exam and obtain x-rays. If surgery is a possibility, a CT scan or MRI may be ordered.

How is it treated?
Non-operative

Most proximal humerus fractures can be treated without surgery. Your surgeon will prescribe a splint or a sling for up to six weeks. Physical therapy to maintain shoulder range of motion begins as soon as the patient can tolerate it. This prevents stiffness in the shoulder. Periodic x-rays will be obtained to be sure the fracture is healing.

Operative
Your surgeon may recommend an operation if the fracture fragments are displaced, or separated from the other fragments. If displaced fragments heal out of position, the patient may lose motion in the shoulder, or develop arthritis. Operative treatment depends on the location of the fracture.

Greater tuberosity fractures occur where the rotator cuff attaches to the top of the humerus. The rotator cuff generally remains attached to the fragment. If a fragment is displaced more than 5 mm, open reduction and internal fixation should be considered to prevent loss of motion and/or impingement of the rotator cuff. The surgeon will reattach the fragment with screws or suture.

Lesser tuberosity fractures occur where the rotator cuff attaches to the front of the shoulder. The rotator cuff generally remains attached to the fragment. If this fragment is displaced, the patient will have increased rotation of the arm and be at risk for shoulder instability. These fractures are repaired with screws or sutures.

Anatomic neck fractures often involve the joint surface, and may require a SuturePlate and screws to repair. If the joint surface is damaged or loses its blood supply, a shoulder replacement may be necessary. Surgical neck fractures occur where the ball of the humerus meets the shaft. Isolated surgical neck fractures, if displaced, can be treated with a SuturePlate, a rod inside the bone, or percutaneous pinning.

Fractures that involve two or three of the parts will often require a SuturePlate to repair. Fractures that involve all four parts of the humeral head are generally treated with a shoulder replacement. If the rotator cuff is irreparably torn, four-part fractures can be treated with a special shoulder replacement called a reverse ball and socket prosthesis. A reverse ball and socket prosthesis is engineered to allow the patient to move the shoulder without the need for a functioning rotator cuff.

b. Clavicle

What is a Clavicle Fracture?
A clavicle fracture is a broken collarbone. A clavicle fracture is classified by its location. There are three types: proximal, mid-shaft and distal.

What causes a Clavicle Fracture?
Fractures of the collarbone are caused by trauma. Falls, motor vehicle accidents, sporting injuries and direct blows to the collarbone are common causes.

What are the symptoms?
Patients with collarbone fractures have pain and swelling over the fracture. There is often a visible bump where the fracture is located. Bruising at the fracture site is common, and the fracture is tender to the touch. Patients will have a difficult time lifting their arms over their heads or across their bodies. A click may be heard or felt with shoulder motion.

How is a Clavicle fracture diagnosed?
Your surgeon will perform a physical exam and obtain x-rays. If surgery is a possibility, a CT scan or MRI may be ordered.

How is it treated?
Non-operative

Many clavicle fractures can be treated without surgery. Your surgeon will prescribe a splint or a sling for up to six weeks. Physical therapy to maintain shoulder range of motion begins as soon as the patient can tolerate it. This prevents stiffness in the shoulder. Periodic x-rays will be obtained to be sure the fracture is healing.

Operative
Traditionally, only fractures that threaten or penetrate the skin, are widely displaced or severely shortened, or occur in conjunction with a shoulder blade fracture are given operative consideration.  Recent scientific literature, however, suggests patients treated with an operation may have improved long term outcomes over those that are treated non-operatively.Surgical treatment options include a plate and screws or intra-medullary rodding of the clavicle.

c. Acromion

What is an Acromion Fracture?
An acromion fracture is a break in the top part of the shoulder blade. The acromion is an extension of the shoulder blade that overlies the rotator cuff and forms the acromioclavicular joint with the collarbone.

What causes an Acromion Fracture?
Fractures of the acromion are caused by trauma. Falls, motor vehicle accidents, sporting injuries and direct blows to the shoulder blade are common causes. An os acromiale is an unfused growth plate in the acromion.

What are the symptoms?
Patients with acromion fractures have pain and swelling over the fracture. There is often a visible bump where the fracture is located. Bruising at the fracture site is common, and the fracture is tender to the touch. Patients will have a difficult time lifting their arms over their heads or across their bodies.  A click may be heard or felt with shoulder motion.  Because of its proximity to the rotator cuff, patients with acromion fractures or an os acromiale may experience inflammation of their rotator cuff.

How is an Acromion fracture diagnosed?
Your surgeon will perform a physical exam and obtain x-rays. A CT scan may be obtained to better visualize the fracture. An MRI may be ordered to determine the effect of the fracture on the rotator cuff.

How is it treated?
Non-operative

Many acromion fractures can be treated without surgery. Your surgeon will prescribe a splint or a sling for up to six weeks. Physical therapy to maintain shoulder range of motion begins as soon as the patient can tolerate it. This prevents stiffness in the shoulder. Periodic x-rays will be obtained to be sure the fracture is healing.

Operative
Surgical treatment is limited only to widely displaced fractures and those that impinge the rotator cuff. Surgical options include screws, suture or a plate. Os acromiales, if symptomatic, can be treated with screws, arthroscopic decompression, or excision if the fragment is small.

d. Glenoid

What is a Glenoid Fracture?
A glenoid fracture is a break in the part of the shoulder blade that forms the socket of the shoulder.

What causes a Clavicle Fracture?
Fractures of the glenoid are caused by trauma. Falls, motor vehicle accidents, sporting injuries and shoulder dislocations are common causes.

What are the symptoms?
Patients with glenoid fractures have pain and swelling in the shoulder. Patients will have a difficult time lifting their arms over their heads or across their bodies. A click may be heard or felt with shoulder motion.

How is a Glenoid fracture diagnosed?
Your surgeon will perform a physical exam and obtain x-rays. A CT scan may be obtained to better visualize the fracture.

How is it treated?
Non-operative

Many glenoid fractures can be treated without surgery. Your surgeon will prescribe a splint or a sling for up to six weeks. Physical therapy to maintain shoulder range of motion begins as soon as the patient can tolerate it. This prevents stiffness in the shoulder. Periodic x-rays will be obtained to be sure the fracture is healing.

Operative
Glenoid fractures that are displaced will require operative repair. This is generally accomplished with screws placed across the fracture.

e. Scapula

What is a Scapula Fracture?
A scapula fracture is a break in the shoulder blade.

What causes a Scapula Fracture?
Fractures of the scapula are caused by trauma. Falls, motor vehicle accidents, sporting injuries and direct blows to the upper back are common causes.

What are the symptoms?
Patients with scapula fractures have pain, swelling and bruising over the shoulder blade. Patients will have a difficult time lifting their arms over their heads. A click may be heard or felt with shoulder motion.

How is a Scapula fracture diagnosed?
Your surgeon will perform a physical exam and obtain x-rays. A CT scan may be obtained to better visualize the fracture.

How is it treated?
Non-operative

Scapula fractures rarely require surgery. The shoulder blade is encased in muscle tissue, which helps to hold fracture fragments in position. Your surgeon will prescribe a splint or a sling for up to six weeks. Physical therapy to maintain shoulder range of motion begins as soon as the patient can tolerate it. This prevents stiffness in the shoulder. Periodic x-rays will be obtained to be sure the fracture is healing.

Operative
Only high-energy fractures of the shoulder blade, or those associated with displacement of the glenoid require surgery. Contoured plates and screws are used for fixation.

Leave a Reply

Your email address will not be published. Required fields are marked *