What is a Shoulder Fracture?
A break in the bones that makes up the shoulder joint is called a shoulder fracture. The clavicle (collarbone) and top end of the humerus ( humeral head) closest to the shoulder are the bones that usually are fractured. The scapula, or shoulder blade, is not easily fractured because of its protective cover of surrounding muscles.
Causes
Clavicle and humerus fractures generally occur by direct trauma to the shoulder region. Examples of such injuries include a fall from a bike or the result of a motor vehicle accident, collision during contact sport, or even a mechanical slip/trip and fall. A fracture of the scapula typically only occurs by high-energy trauma for example from a high-speed motor vehicle accident.
Signs and Symptoms
The common signs and symptoms may include:
- Pain
- Swelling
- Bruising
- Difficulty in lifting the arm
- Numbness, tingling or coldness of the hand and forearm
- A crunching sound also referred to as crepitus, heard or felt at the time of the fracture or with moving the limb after
Diagnosis
A shoulder fracture is usually diagnosed based on a thorough physical examination, and imaging studies such as X-rays and CT scans.
Treatment
The treatment for a shoulder fracture is based on the type of fracture. Treatment can include either non-surgical or surgical methods.
Clavicle Fracture Care
A broken clavicle usually heals without the need for surgery, especially in people under the age of 20, but if the bone ends have shifted markedly out of place (displaced), surgery may be recommended to align the bone ends and hold them stable during healing.
Surgery for clavicle fractures may also be considered in the following circumstances:
- Multiple fractures
- Compound (open) fractures
- Fractures associated with nerve or blood vessel damage and/or scapula fracture
- Overlapping of the broken ends of bone (shortening of the clavicle by more than 2 cm)
Plates and Screws
During this procedure, your surgeon will reposition the broken bone ends into their normal position and then use special screws or metal plates to hold the bone fragments in place. These plates and screws are usually left in the bone. If they cause irritation, they can be removed after the fracture heals.
Percutaneous Elastic Intramedullary Nailing
Occasionally considered for fixation of displaced clavicle fractures in adolescents and athletes, as it potentially allows for more rapid healing and a faster return to sports. The procedure is performed under fluoroscopic guidance (live x-ray). It involves a 1-cm incision near the sternoclavicular joint (where the collarbone meets the breastbone), after which an elastic nail is inserted inside the canal of the clavicle. Then the nail is manipulated to reach the fracture site. A second operation to remove the nail is required after 2-3 months.
Proximal Humerus Fracture Care
Most proximal humerus fractures are minimally displaced and can be treated with conservative approaches such as the use of a collar and cuff type of sling to immobilize for the first 2 to 3 weeks and then early physical therapy to improve the functional outcome.
Although most proximal humerus fractures will heal with non-operative treatment surgery may be necessary for displaced fractures in order to try and improve the functional outcome.
In general, the multiple fragments are fixed with plates and screws or pins, or with the use of an intramedullary nail. In severe cases, shoulder replacement surgery may be required.