Fractures can occur to all 3 bones that comprise the shoulder joint. Emergency treatment of these injuries is provided by LTHTR but subsequent treatment and follow up can be arranged at both LTHTR or in one of the units of the Upper Limb Centre.
CLAVICLE FRACTURES
The clavicle or collar bone is one of the commonest bones broken. Most fractures occur in young children who fall forward onto their outstretched hand. The force of the impact is transmitted up the arm breaking the middle part of the collar bone. These injuries almost never require surgical treatment and heal very well using a sling for a few weeks. In adults again most fratures can be treated in a sling and it is only when the bone is significantly displaced and/or in multiple fragments that surgery may be required the shape of the bone and its function. If surgery is required then the bone is usually fixed with a special contoured metal plate and screws.
High energy clavicle fracture in 3 pieces Same fracture repair with plate and 9 screws
PROXIMAL HUMERAL FRACTURES
Most fractures of the upper end of the humerus occur in falls with a violent impact to the upper arm. They are most common in patients aged 60 and over. They are often linked to osteoporosis and older patients with these injuries should discuss the possibility of osteoporosis with their GP. The GP can arrange a scan to assess the general bone strength and tablet treatments can be started to reduce the risk of futute breaks.
As above with the clavicle, if the bone fragments remain in a relatively normal position then the fracture can be treated in a sling with physiotherapy starting at around 3 to 4 weeks once the pain starts to reduce as the bone heals. Surgery needs to be considered in situations when the bone fragments come apart or displace. The decision to operate must be made by the patient with the advice of their surgeon. The surgeon should be able to give the patient his opinion as what the function is likely to be if surgery is rejected as an option. In general terms the more fragmented the bone and the more displaced those fragments are the likelier the result will be poor without surgery. When surgery is performed the objective is to restore as much as possible the shape of the bone and also reattach as strongly as possible the rotator cuff tendons. Fixation of the bone is achieved using special metal plates and screws that are able to hold the fragments firmly while healing occurs. The surgeon is trying to produce a repair that is strong enough to allow the patient to start moving the shoulder as soon as possible. One of the biggest risks in these injuries is stiffness and moving the shoulder as early as possible reduces this risk. The other major factor in deciding on surgery is the risk of going through an anaesthetic and in patients with poor general health should discuss these risks with both their surgeon and anaesthetist.
In some circumstances the shoulder fracture is so severe that repair is not possible and in this case a shoulder replacement operation can be performed. It is also possible that the surgeon during surgery may consider the fracture to be not repairable and decide to perform a shoulder replacement. For this reason any theatre performing shoulder fracture treatment must be equiped to perform shoulder replacement surgery.
SCAPULAR FRACTURES
Scapula fractures are very uncommon and usually happen in very high energy injuries like falls from buildings or in road traffic accidents involving pedestrians. As long as the joint surface of the glenoid fossa is not disrupted these injuries are usually treated in a sling. There are several large powerful muscles that normally wrap around the scapula and these muscles help to splint the bone in position while it heals. in fractures were there is disruption of the joint surface surgery is often required using specialised plates and screws.
