The document discusses various types of shoulder injuries including fractures and dislocations. It describes the anatomy of the shoulder joint and then covers specific fractures of the clavicle, scapula, and humerus. Treatment options for each injury are discussed, including nonsurgical treatments like slings or bandages and indications for surgical intervention. Various types of shoulder dislocations are also outlined, along with their mechanisms, clinical presentations, diagnoses, and approaches to reduction.

1. Shoulder Fractures & Dislocations
By: Amin Yousefelahi
Rafsanjan Medical School

2. Shoulder Joint
• It’s a connector of Upper limbs to the body
• It’s an unstable joint and it’s highly dependent to the
muscles and ligaments to be stable.
• It’s the most unstable joint in the body thus dislocation
is very common.

3. Shoulder Joint
Bones
•Clavicle
•Scapula
•Humerus (head)

4. Shoulder Joint
Ligaments
•Coracoclavicular
•Acromiacalvicular
•Coracoacromial

5. Clavicle Fractures

6. Clavicle Fractures
Epidemiology
•One of the most common bony injuries
•The most fracture in the children and teenagers
Mechanisms
•Fall on the outstretched hand
•Direct traumas

7. Clavicle Fractures
Clinical manifestation
•Sight: swelling & ecchymosis
•Touch: pain & tenderness maybe with crepitation
•ROM: its restricted and painful
Diagnosis
•First of all with history and PE
•With XR AP

8. Clavicle Fractures
Classification
1.1/3 middle: the most common (80%)
2.1/3 distal: it has three types (15%)
i. Type I: minimally displaced; between ligaments.
ii. Type II: minimally displaced; between ligaments.
iii. Type III: Fracture through AC joint. Ligaments intact
3.1/3 proximal (5%)

9. Clavicle Fractures
1/3 distal: it has three types

10. Clavicle Fractures
Treatment
•Non surgical: in the most cases
• Fixation and limit the movement of the shoulder
• Triangle bandage
• Figure of 8
• Sling
sling

11. Clavicle Fractures Treatment
•Surgical
• Internal fixation
• Indication for surgical operation
1. Nonunion. This is the most frequent indication.
2. Neurovascular involvement. Neurovascular compromise not easily resolved by
reduction of the fracture requires immediate open reduction.
3. Fracture of the lateral end near the acromioclavicular joint in an adult.
4. A persistent wide separation of the fragments with interposition of soft tissue.
5. Floating shoulder. Fractures of the clavicle and the surgical neck of the scapula
make the scapular fracture unstable.
6. Its recommended open fixation for type II fracture.

13. Floating shoulder

15. Scapula Fracture
Epidemiology And Etiology
•Fracture of coracoid, acromion and body of the scapula commonly
caused by direct traumas and accidents.
•Fracture of neck of the scapula (glenoid) commonly caused by falling
and indirect traumas.
Clinical Manifestation
•Sight: ecchymosis, erosion, swelling and maybe with deformity
•Touch: tenderness, painful and maybe criptation

16. Scapula Fracture
• ROM: limited and painful

17. Scapula Fracture
Diagnosis
•X ray
• CT often is necessary for accurate
assessment of these injuries
Treatment
•Non surgical
• Most fractures can be treated by sling and
instituting early active motion
• In first 18h we can use the ice bag for bleeding limitation

18. Scapula Fracture
• Surgical: following fractures may require open reduction and internal fixation
1. Significantly displaced fractures of the acromion and lateral scapular spine with retraction of
the fragment and encroachment on the subacromial space
2. Fractures of the coracoid with acromioclavicular separation
3. Glenoid rim fractures

19. Fracture-Dislocations of
the Shoulder • If shoulder dislocation + great humerus tuberosity fracture
• In these cases reduction of the shoulder also will cause tuberosity dislocation
and commonly don’t open reduction
• If close reduction was unsuccessful open reduction is needed.
• If shoulder dislocation + head or neck of humerus
• Surgery is needed at first

20. Proximal Humeral Fractures
• Neer classification
• Another classification
• Great tuberosity Fracture
• Surgical neck fracture
• Diagnosis
• Ap shoulder in plan of scapula
• Lateral of scapula
• Spine axillary view
• CT scan if other x rays were not enough

21. Great Tuberosity Fracture
Etiology
•Falling when the arm is abduct and usually are with shoulder joint
dislocation
•Sudden supraspinatus retraction
Clinical Manifestation
•Edema
•Painful abduction

22. Great Tuberosity Fracture
Diagnosis
•Lateral x ray
•CT
Treatment
•3 to 4 weeks with SLING or TRIANGULAR bandage.
•If fracture was with displacement it is indication for SURGERY.

24. Surgical Neck Fracture
Etiology
•Falling
• It could be with no displacement or displacement
Clinical Manifestation
•ROM painful and limited
•If the fracture pieces stuck together the
Patient can abduct the arm!

25. Surgical Neck Fracture
Treatment
•Velpeau bandage for 2weeks
•In young people with
displacement, Surgery should be
done
•In old people with displacement it has high risk for avascular necrosis
we should replace the fractured pieces with Neer prosthesis or
• Percutaneous pinning
• Intramedullary nailing

26. Acromioclavicular
Etiology Dislocation
•It is common in the athletes
•Falling
•It has different types
Clinical Manifestation
•Edema and bulging the clavicle
•Tenderness in AC joint ligament
Diagnosis
•With shoulder AP
•If its partial dislocation, radiographies could be normal
•If it is complete dislocation, clavicle goes superior to acromion

28. Acromioclavicular
Dislocation
Treatment
•It is controversy between the surgical or nonsurgical
•For complete dislocation it is better to do operation
•For partial SLING is enough
•Commonly it doesn't need surgery.

29. Sternoclavicular
Dislocation Etiology
•Falling when the pressure is on the medial side of the shoulder.
•In most cases ANTERIOR dislocation, happens but if the
POSTERIOR happened it would be more dangerous.
Clinical Manifestation
•Swelling in the medial part of the clavicle
Diagnosis
•CT scan

31. Sternoclavicular
Dislocation
Treatment
•Reduction under the general anesthetic. Sometimes for fixation
they use pin

32. ANT Shoulder Dislocation
Etiology
•Falling on the shoulder when the arm is abducted and is in ext
rotation.
•It is common in the wrestling, epilepsy and electricity Shock
Clinical Manifestation
•Deformity in the shape of the arm(two angles on the shoulder)
•If circumflex axillary nerve hurts, paresthesia can be detect in lateral
and proximal of the arm.(on the deltoid)
•We can touch the head of the humerus under the clavicle
•ROM is limited and painful

34. ANT Shoulder Dislocation
Diagnosis
•Lateral shoulder X ray
Treatment
•Reduction the most common method is Traction and counter traction
•Stimson method

35. POST Shoulder
Dislocation
Etiology
•Falling on the shoulder when the arm is abducted and in internal
rotation.
•It is more common in epilepsy and electricity Shock
Clinical Manifestation
•Deformity in the shape of the arm
•We can touch the head of the humerus posterior of the arm.
•ROM is limited and painful

36. POST Shoulder
Dislocation Diagnosis
•Lateral shoulder X ray
Treatment
•Reduction
•If the reduction was failed
Open reduction
•if the it was open
Dislocation then open reduction

37. Thanks for your attention