Fractures of the Shoulder Region

What are the indications for an ORIF procedure?

1) Failed closed treatment (loss of reduction or poor patient tolerance/compliance) 2) Open fractures 3) Vascular injury/neurologic injury

What are the possible complications following a shoulder fracture?

1) Frozen shoulder/elbow 2) Radial nerve damage 3) RC injury 4) Avascular necrosis 5) GH dislocations and labral tears 6) Secondary OA 7) Sprains of SC, AC, and fractured ribs 8) Suprascapular nerve damage 9) Mal-union or non-union 10) Excess callous formation 11) Injury to subclavian artery or BP or axillary nerve 12) Pleural penetration by fracture fragments

How do patients typically present following a fracture to the clavicle?

1) Guarded shoulder motions and difficulty elevating the arm above 60 degrees 2) Clavicular deformity 3) Extreme tenderness to palpation or percussion over fracture site 4) Horizontal ADD is painful 5) Confirmed with radiograph

What are the indications for surgery following a scapular fracture?

1) If the fracture is significantly displaced 2) If the shoulder is floating (fractures of both the clavicle and surgical neck of the scapula)

What are the considerations for closed treatment following a fracture to the proximal 1/3 of the humerus?

1) Patient age 2) Displacement of surgical neck, tuberosities, and articular surface 3) Functional demand 4) Arm dominance 5) Ability to salvage with an arthroplasty later if needed

What are the methods of closed treatment following a fracture to the proximal 1/3 of the humerus?

1) Sling 2) Sling and swath 3) Hanging cast 4) ABD pillow

What is a Group II Clavicle Fracture?

A fracture of the distal third of the clavicle. Accounts for 10-15% of all clavicle injuries

What is a Group I Clavicle Fracture?

A fracture of the middle third of the clavicle. Is the most common type

What is one of the most common shoulder region fractures in the young and elderly?

A fracture of the proximal 1/3 of the humerus

What is the most commonly fractured bone in childhood?

Clavicle

If a scapular fracture was to occur, what is the most likely MOI?

Direct impact on the scapula or force transmitted up through the humerus

What are the most common MOI's associated with a proximal humeral shaft fracture?

Direct impact or FOOSH

Fractures of the anatomical neck of the humerus are common among what age of individuals?

Elderly and adolescents

What is the most common MOI associated with a fracture of the anatomical neck of the humerus?

FOOSH

Proximal humeral shaft fractures are a common site for...

Metastases in cancer

Scapular fractures are most commonly associated with what other fractures?

Rib fractures, clavicle fractures, as well as possible pulmonary injury

What is a Group III Clavicle Fracture?

A fracture of the medial third of the clavicle. Is the least common (about 5%)

When is surgical intervention needed for patients who have had a fracture of the clavicle?

For cases involving neurovascular compression, an open fracture, as well as associated fractures and marked displacement

When do glenoid rim fractures most often occur?

From a fall onto a flexed elbow

Are scapular fractures common?

No, they represent 1% of all fractures, and 5% of fractures involving the shoulder

If a fracture is unstable, when should sub-maximal isometrics begin?

Should wait until bony union as muscle pull could disrupt the reduction

If a fracture is stable, when should sub-maximal isometrics begin?

Week 1

If an individual has a scapular fracture, how do they typically present?

There will be tenderness, edema, and ecchymosis over the affected area. The arm is held in adduction, and there is usually pain with any attempt to abduct the arm

What type of fractures typically occur with proximal humeral shaft fractures?

Transverse or comminuted