Shoulder Fractures Flashcards by Kelliane Tambe

joints around shoulder

glenohumeral joint
Acromioclavicular joint
Sternoclavicular joint
Scapulothoracic joint

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connective tissue in shoulders

glenoid labrum
ligaments
bursae

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causes of fractures in clavicle

Direct blow on the point of the shoulder

fall on outstretched hand

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site of injury in clavicle

junction mid/outer 1/3
Middle 1/3
outer 1/3
more less acromioclavicular joint injury 
\+/- Sternoclavicular joint injury

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examinations made in clavicle fractures

Check for tenting
May be an impending open fracture
Check for an neurovascular deficits (brachial plexus injury)

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what vessel should we be careful about when looking at clavicle fracture

Subclavian vessels proximity to clavicle

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treatment of undisplaced clavicle fractures

Broad arm sling up to 3/52 or Figure of 8 bandage
Must provide support for weight of the arm
Commence ROM ex at 3-4 weeks

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treatment of displaced clavicle fractures

ORIF + Sling.

Longer period of immobilisation

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types of reduction needed for middle third clavicle fracture

no reduction

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types of reduction need for lateral third clavicle fracture

undisplaced - no reduction

displaced - refer to nearest orthopaedic service on call

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type of reduction needed for medial third clavicle fracture

undisplaced - no reduction

displaced -refer to nearest orthopaedic service on call

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immobilisation method for middle third and duration for clavicle fracture

broad arm sling for 2-3 weeks or until comfy

regular analgesia

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immobilisation method for lateral third and duration for clavicle fracture

broad arm sling to support limb for 4 weeks or until comfy

regular analgesia

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immobilisation method for medial third and duration for clavicle fracture

broad arm sling to support limb

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complications of clavicle fractures

Comminution with separation (bone is broken into multiple pieces)
Skin penetration (open fracture)
Associated nervous and vascular trauma/damage (brachial plexus or supraclavicular nerves)
Nonunion after several months (3–6 months, typically)
Deformity
Displaced distal third fractures (high risk of nonunion)

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causes of AC joint injury

Blow to shoulder downward force e.g. rugby or hockey

Grade 1 – 6 (ref Shoulder STI lecture

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examination of AC joint injury

Tenderness
Palpable step
Arm may look longer
AP X-Ray

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treatment for stable AC joint injury

Grades 1-3
Sling 4 - 6/52
Commence ROM after this

treatment for unstable AC injury for grades 4-6

Grades 4-6
ORIF screw / realign
+ Sling / body-bandage x 4 - 6 weeks

types of SC joint dislocation

anterior and posterior dislocation

anterior dislocation of SC joint causes

Uncommon
Fall on hand / shoulder forces inner end clavicle forward
High energy force

treatment of anterior dislocation of SC joint

Reduce
Sling 2 - 3 weeks
+/- ORIF + brace 4 - 5 weeks

posterior dislocation of SC joint

more serious

treatment of posterior dislocation of SC joint

ORIF

Cause of fracture of scapula

Usually direct violence

location of fractures on scapula

Spine Coracoid Acromion Body

treatment for fracture of scapula

Usually broad arm sling for 2-4 weeks | Followed by ROM/physio

common location of fracture in proximal humerus

Neck of humerus | Avulsion # Greater Tuberosity

causes of avulsion greater tuberosity humerus

Forceful avulsion of supraspinatus tendon | Fall on shoulder in older patients

treatment for avulsion greater tuberosity humerus in undisplaced injury

Support (Collar and Cuff) x 2-3 weeks | Early mobilisation

treatment for avulsion greater tuberosity humerus in displaced injury

ORIF | Collar and Cuff for 4-6 weeks

causes of fracture on surgical neck of humerus

fall on outstretched hand

categorising fracture of surgical neck of humerus

Stable / unstable | Displaced / impacted

complications of surgical neck of humerus

Non-union | Damage blood vessel / nerve

management of surgical neck of humerus fracture - Stable

Can be impacted or non-impacted Non-impacted Collar + cuff x4 - 6 weeks Mobilisation after this

management of surgical neck of humerus fracture - impacted

Collar + cuff x 2/52 | Mobilisation after 2 weeks

management of surgical neck of humerus fracture - unstable/displaced

ORIF Collar + cuff x4 - 6 weeks Mobilisation after this

causes of fracture of shaft humerus

Direct violence | Indirect violence e.g. Fall

types of fracture of shaft humerus

Spiral Transverse Pathological

complications associated with fracture of shaft humerus

Radial nerve palsy Mal-union) – proximal fragment abducted (Deltoid ‘pull’) Non-union

radial nerve palsy

wrist drop Weak/absent wrist and finger extension Reduced /absent sensation dorsum of wrist+/- forearm

management of radial nerve palsy

``` May take number of weeks to recover Maintain passive ROM Splinting (dynamic or resting splint) Sensory awareness Strengthening once recovery occurring ```

conservative treatment of shaft humerus fracture

Surrounding musculature stabilise / weight of arm U slab / hanging cast + collar + cuff If position unacceptable may require ORIF

ORIF treatment of shaft humerus fracture

Plate and screws Intramedullary (IM) nailing Minimally invasive percutaneous osteosynthesis (MIPO).