Shoulder Fractures & Dislocations

By: Amin YousefelahiRafsanjan Medical School

Shoulder Joint• It’s a connector of Upper limbs to the body• It’s an unstable joint and it’s highly dependent to the muscles and ligaments to be stable.• It’s the most unstable joint in the body thus dislocation is very common.

Shoulder JointBones•Clavicle•Scapula•Humerus (head)

Shoulder Joint

Ligaments•Coracoclavicular•Acromiacalvicular•Coracoacromial

Clavicle Fractures

Clavicle FracturesEpidemiology•One of the most common bony injuries•The most fracture in the children and teenagers

Mechanisms•Fall on the outstretched hand•Direct traumas

Clavicle FracturesClinical manifestation•Sight: swelling & ecchymosis•Touch: pain & tenderness maybe with crepitation•ROM: its restricted and painful

Diagnosis•First of all with history and PE•With XR AP

Clavicle FracturesClassification1.1/3 middle: the most common (80%)2.1/3 distal: it has three types (15%)

i. Type I: minimally displaced; between ligaments.ii. Type II: minimally displaced; between ligaments.iii. Type III: Fracture through AC joint. Ligaments intact

3.1/3 proximal (5%)

Clavicle Fractures1/3 distal: it has three types

Clavicle FracturesTreatment•Non surgical: in the most cases• Fixation and limit the movement of the shoulder

• Triangle bandage

• Figure of 8

• Sling

sling

Clavicle FracturesTreatment•Surgical

• Internal fixation• Indication for surgical operation

1. Nonunion. This is the most frequent indication.

2. Neurovascular involvement. Neurovascular compromise not easily resolved by reduction of the fracture requires immediate open reduction.

3. Fracture of the lateral end near the acromioclavicular joint in an adult.

4. A persistent wide separation of the fragments with interposition of soft tissue.

5. Floating shoulder. Fractures of the clavicle and the surgical neck of the scapula make the scapular fracture unstable.

6. Its recommended open fixation for type II fracture.

Floating shoulder

Scapula FractureEpidemiology And Etiology•Fracture of coracoid, acromion and body of the scapula commonly caused by direct traumas and accidents.•Fracture of neck of the scapula (glenoid) commonly caused by falling and indirect traumas.

Clinical Manifestation•Sight: ecchymosis, erosion, swelling and maybe with deformity•Touch: tenderness, painful and maybe criptation

Scapula Fracture• ROM: limited and painful

Scapula FractureDiagnosis•X ray• CT often is necessary for accurate assessment of these injuries

Treatment•Non surgical

• Most fractures can be treated by sling and instituting early active motion• In first 18h we can use the ice bag for bleeding limitation

Scapula Fracture• Surgical: following fractures may require open reduction and internal

fixation1. Significantly displaced fractures of the acromion and lateral scapular spine with

retraction of the fragment and encroachment on the subacromial space2. Fractures of the coracoid with acromioclavicular separation3. Glenoid rim fractures

Fracture-Dislocations of the Shoulder

• If shoulder dislocation + great humerus tuberosity fracture• In these cases reduction of the shoulder also will cause tuberosity

dislocation and commonly don’t open reduction

• If close reduction was unsuccessful open reduction is needed.

• If shoulder dislocation + head or neck of humerus• Surgery is needed at first

Proximal Humeral Fractures• Neer classification• Another classification

• Great tuberosity Fracture• Surgical neck fracture

• Diagnosis• Ap shoulder in plan of scapula• Lateral of scapula• Spine axillary view• CT scan if other x rays were not enough

Great Tuberosity Fracture

Etiology•Falling when the arm is abduct and usually are with shoulder joint dislocation•Sudden supraspinatus retraction

Clinical Manifestation•Edema •Painful abduction

Great Tuberosity Fracture

Diagnosis•Lateral x ray•CT

Treatment•3 to 4 weeks with SLING or TRIANGULAR bandage.•If fracture was with displacement it is indication for SURGERY.

Surgical Neck FractureEtiology•Falling

• It could be with no displacement or displacement

Clinical Manifestation•ROM painful and limited•If the fracture pieces stuck together the

Patient can abduct the arm!

Surgical Neck FractureTreatment•Velpeau bandage for 2weeks•In young people with displacement, Surgery should bedone•In old people with displacement it has high risk for avascular necrosis we should replace the fractured pieces with Neer prosthesis or

• Percutaneous pinning• Intramedullary nailing

Acromioclavicular DislocationEtiology

•It is common in the athletes•Falling•It has different types

Clinical Manifestation•Edema and bulging the clavicle •Tenderness in AC joint ligament

Diagnosis •With shoulder AP•If its partial dislocation, radiographies could be normal•If it is complete dislocation, clavicle goes superior to acromion

Acromioclavicular Dislocation

Treatment•It is controversy between the surgical or nonsurgical•For complete dislocation it is better to do operation•For partial SLING is enough•Commonly it doesn't need surgery.

Sternoclavicular Dislocation

Etiology•Falling when the pressure is on the medial side of the shoulder. •In most cases ANTERIOR dislocation, happens but if the POSTERIOR happened it would be more dangerous.

Clinical Manifestation•Swelling in the medial part of the clavicle

Diagnosis•CT scan

Sternoclavicular Dislocation

Treatment•Reduction under the general anesthetic. Sometimes for fixation they use pin

ANT Shoulder Dislocation

Etiology•Falling on the shoulder when the arm is abducted and is in ext rotation.•It is common in the wrestling, epilepsy and electricity Shock

Clinical Manifestation•Deformity in the shape of the arm(two angles on the shoulder)•If circumflex axillary nerve hurts, paresthesia can be detect in lateral and proximal of the arm.(on the deltoid)•We can touch the head of the humerus under the clavicle•ROM is limited and painful

ANT Shoulder Dislocation

Diagnosis•Lateral shoulder X ray

Treatment•Reduction the most common method is Traction and counter traction•Stimson method

POST Shoulder Dislocation

Etiology•Falling on the shoulder when the arm is abducted and in internal rotation.•It is more common in epilepsy and electricity Shock

Clinical Manifestation•Deformity in the shape of the arm•We can touch the head of the humerus posterior of the arm.•ROM is limited and painful

POST Shoulder Dislocation

Diagnosis•Lateral shoulder X ray

Treatment•Reduction •If the reduction was failed Open reduction•if the it was open Dislocation then open reduction

Thanks for your attention