The document discusses common shoulder fractures including clavicle fractures, proximal humeral fractures, shoulder dislocations, and humeral shaft fractures. Clavicle fractures most often occur in the lateral third and are usually treated conservatively with a sling. Proximal humeral fractures are common in the elderly and often involve the surgical neck. They are typically treated with a sling or internal fixation depending on the degree of displacement. Shoulder dislocations are usually anterior and require reduction, which may need to be done under anesthesia if there is a fracture. Humeral shaft fractures have varying displacement depending on the fracture level and are commonly treated conservatively with a sling or brace, but surgery is indicated for more complex cases. Early mobil

1. Common
Shoulder
FracturesPuneet Monga
Consultant Orthopaedic Surgeon
Upper Limb Unit,
Wrightington Hospital

3. Clavicle fractures
Direct fall usual mechanism
Lateral 1/3 (21%), middle 1/3
(76%), medial 1/3 (3%)
Beware; associated injuries
eg. Rib, scapula #
Proximal fragment pulled up,
distal gravitates down

4. Treatment of clavicle fractures
Good union rate treated conservatively; broad
arm sling
Operate if:
Short by > 2cm
Open # or skin tenting
Neurovascular injury
Pathological fracture
Floating shoulder
? Polytrauma
? Non-union

5. When can we start moving
Non operative Operative

7. Proximal humeral fractures
Common in elderly
Always ask for
complete trauma
series
Combination of
Surgical neck #
Anatomical neck #
Greater tuberosity #
Lesser tuberosity #

8. Proximal humeral fractures
Sling (85%)
Internal fixation (displaced #s)
Replacement (# dislocations)

9. When can we start moving
Non operative Operative

11. Dislocation of the shoulder
Commonly anterior
Beware Axillary nerve injury
Reduction methods
Kocher
Hippocratic
Traction and manual reduction
If it is a # dislocation, reduce
it under GA !!!!

12. When can we start moving
Non operative Operative

14. Humeral shaft fracture
3% of all fractures
Muscular attachments of
deltoid and pectoralis
cause differing degrees of
displacement depending on
level of fracture
Beware; radial nerve palsy

15. Humeral shaft fracture treatment
Conservative (70-80%)
U slab aligns fracture
Functional brace – early
mobilisation (in 2-3 wks)

16. Humeral shaft fracture treatment
Surgery – Plate or IM Nail
Indications for surgery
➢ Closed treatment failed
➢ open fracture
➢ vascular injury
➢ floating elbow
➢ pathological #
➢ Polytrauma
➢ articular injury
➢ distal 1/3 #

17. Radial nerve palsy
Presents with wrist drop
11% of humeral fractures
Distal 1/3 fractures most at risk
90% neuropraxia and will recover
(3-4m)
Treat with observation and wrist
extension splint
Surgically explore if: open #, or
appears after manipulation

18. When can we start moving
Non operative Operative

19. Global summary
Early surgery when indicated.
Early mobilization, esp after surgery.
Mobilize neighboring joints ASAP.
Team working crucial for good outcomes