Shoulder Fractures Flashcards
joints around shoulder
glenohumeral joint
Acromioclavicular joint
Sternoclavicular joint
Scapulothoracic joint
connective tissue in shoulders
glenoid labrum
ligaments
bursae
causes of fractures in clavicle
Direct blow on the point of the shoulder
fall on outstretched hand
site of injury in clavicle
junction mid/outer 1/3 Middle 1/3 outer 1/3 more less acromioclavicular joint injury \+/- Sternoclavicular joint injury
examinations made in clavicle fractures
Check for tenting
May be an impending open fracture
Check for an neurovascular deficits (brachial plexus injury)
what vessel should we be careful about when looking at clavicle fracture
Subclavian vessels proximity to clavicle
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
treatment of displaced clavicle fractures
ORIF + Sling.
Longer period of immobilisation
types of reduction needed for middle third clavicle fracture
no reduction
types of reduction need for lateral third clavicle fracture
undisplaced - no reduction
displaced - refer to nearest orthopaedic service on call
type of reduction needed for medial third clavicle fracture
undisplaced - no reduction
displaced -refer to nearest orthopaedic service on call
immobilisation method for middle third and duration for clavicle fracture
broad arm sling for 2-3 weeks or until comfy
regular analgesia
immobilisation method for lateral third and duration for clavicle fracture
broad arm sling to support limb for 4 weeks or until comfy
regular analgesia
immobilisation method for medial third and duration for clavicle fracture
broad arm sling to support limb
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)
causes of AC joint injury
Blow to shoulder downward force e.g. rugby or hockey
Grade 1 – 6 (ref Shoulder STI lecture
examination of AC joint injury
Tenderness
Palpable step
Arm may look longer
AP X-Ray
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).
