Treatment of Shoulder Fractures

A fracture is a break in the bone that commonly occurs as a result of injury, such as a fall or a direct blow to the shoulder. Shoulder joint is the most flexible joint of the body. It allows different motions of the hands making it possible for us to do a vast array of different activities. However its flexibility makes it more prone to injuries. The type of shoulder fracture depends of the age of the patients. Clavicle fractures are more common in children. A fracture of the upper part of the arm (proximal humerus) is more common in elderly individuals and its frequency increases with age.

Proximal Humerus Fractures

Humerus is the upper arm bone and it forms two joints – shoulder joint and elbow joint. The proximal humerus refers to the upper end of the arm bone, which forms shoulder joint.

Causes

Fractures of proximal humerus are common in elderly individuals, suffering from osteoporosis. Fractures may be caused by traumatic injuries such as a fall on outstretched hand, from greater heights or motor vehicle accidents. In younger individuals a severe trauma can cause these fractures.

Proximal humerus fractures can be categorized into 4 groups:

  • Greater tuberosity fractures: Greater tuberosity is the insertion site for attachment of rotator cuff tendons. Greater tuberosity fractures are less common and are seen in cases of shoulder dislocations and in those with osteoporosis
  • Lesser tuberosity fractures: These fractures often caused by posterior shoulder dislocations or traumatic muscle contractions by electrical shock or convulsions. If left untreated, these fractures cause subscapularis muscle (stabilizer and mobilizer muscle) deficiency and requires a major muscle transfer procedure
  • Surgical neck fractures: Fractures of the surgical neck are most common in patients with osteoporotic bone. These fractures also damage the axillary nerve that carries sensory impulses to the shoulder
  • Humeral head fractures: Humeral head fractures are very often in elderly individuals and chances are more in those with osteoporotic bone. These fractures occur in younger individuals by significant trauma whereas a mild traumatic injury can cause fracture in elderly individuals with osteoporosis

In addition to above, another type of proximal humerus fractures is two, three, and four part fractures, a fracture that cause multiple fragmentation of the proximal humerus.

Symptoms

Patients with proximal humerus fracture experience severe pain, swelling, and restricted motion of the shoulder.

Diagnosis

Proximal humerus fracture is diagnosed by physical examination, X-ray of the affected area and/or computerized tomography (CT) scan.

Conservative Treatment Options

Most proximal humerus fractures are minimally displaced and can be treated with conservative approaches such as use of sling to immobilize and early physical therapy to improve the functional outcome.

Surgery

Surgery may be necessary in displaced fractures. The multiple fragments are fixed with plates, screws, or pins and in severe cases a shoulder replacement surgery is performed.

Types of Fractures

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