Fx of the Shoulder Flashcards
Clavicle Fx
80% occur at middle third
15% lateral
5% medial
What is the common site of clavicle fx and what does it result in?
middle third
results in bayonet apposition
Etiology of Clavicle Fx
trauma - fall
pathologic - bone
cyst
What type of clavicle fx require surgery?
- distal clavicle fx near the AC joint
because of the impingement on the rotator
cuff - communition fx
surgery can use plates
Tx of most clavicle fx
SLING
Fx of clavicle can occur from underlying diseases
infection or bone tumor
Distal Clavicle fx
post traumatic can lead to arthritis - joint problem
What is the tx goal for clavicle fx?
restore length
use clavicle strap - unpopular (patient compliance is low)
PROXIMAL clavicle fx
require surgery
hard to replace it back into original place
Complications of clavicle fx
- nonunion when done surgery (won’t heal)
- pneumothorax - the more communiuted the more likely chance of pneumothorax
- subclavian a injury
more sublux of the clavicle the more chance of injury for subclav a.
Fx of the scapula
body
neck
glenoid
acromion
If glenoid of the scapula fx, how to tx?
if displaced or intra-articular
need surgical management
Mechanism of injury of scapula fx
direct trauma
FOOSH
Fx of humerus
Head
Surgical neck
anatomic neck
proximal shaft
How to tx fx of humerus
No surgery
wait 3 wks after putting a sling
multiple portions of the scapula in involved
STABILIZE
CODMAN described the proximal humeral fx
Proximal humeral fractures
adults occur along the lines of the old physeal scars
The 4 anatomic parts of the proximal humerus fx
greater tuberosity
lesser tuberosity
humeral head
humeral diaphysis (shift)
How common is the proximal humerus fx?
more common than hip
4-5% of all fx
affects women more than men = a typical patient is a elderly woman who falls (osteoporosis)
What are the majority of the proximal humerus fx?
nondisplaced fx (still has anatomic alignment)
Neer classification of proximal humerus fx
One part - impacted compression
Two part - greater tuberosity fx
Three part - head separates from the greater tuberosity and shaft
Four part- head , tuberosities, and shaft separate
one part fx
compression - impacted
two part
greater tub. fx
three part
greater tub and head fx
four part
greater tub less tub and head fx
if greater tub. fx what is at risk
rotator cuff
pulled off
displaced
AVN = avascular necrosis of the head of the humerus
result from four part fx
won’t heal
Etiology of proximal humerus fx
FOOSH
decreased abduction
What vessels are destroyed in 4-part fx
anterior and posterior humeral circumflex a.
Tx of one part
non surgical 1-3 immobilization sling pendulum exercises elbow ROM
Tx of two part
surgical neck is fx
REDUCED CLOED AND IMPACTED
open reduction internal fixation can be okay if unstable
Tx of three part
Use ORIF if greater than 5 mm displacement
for greater tuberosity
and suture fixation for lesser tuberosity but this is rare
ORIF
open the skin, put it back in place by plates and screws cement it for elderly used for three part fx (usually) both the tuberosities will heal use wire and suture
Tx 4 part
generally ORIF doesn’t work because the head will collapse down and AVN won’t let it heal properly
AVN
prosthesis is the best tx
Prosthesis of the humerus
replace the humerus
need tuberosities for motions
