Shoulder fracture

A shoulder fracture can occur in one of the three bones that make up the joint: arm, collarbone or shoulder blade.

A collarbone fracture can occur in children or newborns, or be caused by a fall on a bicycle or motorcycle.
An upper arm fracture is more common in the elderly, whereas the shoulder blade breaks very rarely.


Symptoms of shoulder fracture

An upper arm fracture causes:

  • hematoma along the arm and chest on the side of the injured arm;
  • shoulder pain;
  • stiffness and restriction of movement of the arm;
  • swelling of the arm and shoulder;
  • a fracture of the right shoulder is usually a major limitation for the patient, but for left-handed people this is true for the left shoulder;
  • in the case of a fracture with shoulder dislocation, the arm appears deformed and offset downwards, with the acromion (outermost part of the shoulder blade) protruding outwards.

Treatment of a shoulder fracture

In the emergency room, the doctor attaches a splint (such as a cast cast) to the arm and uses an arm sling to hold the elbow in place.
The immediate treatment consists in the application of ice on the shoulder and a painkiller.
Multiple fractures need to be treated surgically, but some stable fractures can heal without surgery.

Non-surgical treatment

If the fracture is undisplaced, all you need is an orthosis or bandage to hold the elbow in position during the healing process. The doctor should closely monitor the healing of the fracture and periodically call the patient to the clinic to repeat radiography.
If after 2-4 weeks none of the bone fragments has shifted, the doctor allows the patient to begin gentle movements of the arm. This may require some sessions with a physical therapist.
The patient is not allowed to lift objects with the injured arm for a few weeks.
The non-surgical approach to a distal fracture of the humerus may require long-term immobilization or a plaster cast.
As a result, the elbow could stiffen and require longer rehabilitation to restore mobility after removal of the cast.
If fragments shift from their natural position, surgery may be necessary for the patient to align the bones and fix them together.

Surgical treatment of an upper arm fracture

The operation for distal upper arm fracture (near the elbow) involves attaching the fragments of the bone to the original site.
Metal prostheses such as plates and screws are used to hold the fragments in place until the bone fully heals.

Surgical indications

Surgery is usually required in the following cases:

  • if the fracture is displaced;
  • with a displaced fracture with shoulder dislocation;
  • in rare cases, the surgeon recommends the use of a nail in a toothed fracture, that is, when the lower part penetrates into the upper one (for example, the bone neck into the head of the bone);
  • if it is an open fracture, i.e. parts of the bone have pierced the skin, the risk of infection is significantly higher than with a closed fracture.

The patient should be given antibiotics through the vein (intravenously) immediately in the emergency room and may need a tetanus booster.
The surgeon recommends surgery to clean the incisions and fix the bone fragments.

In some cases of severe open fracture, the doctor may decide to apply an external fixation (external fixator). In this procedure, screws are inserted into the bones that protrude from the skin and are connected with rods made of aluminum or carbon fiber.
In this way, the bone is temporarily held in position.
This gives the skin time to heal the fracture before surgery, reducing the risk of infection.

Surgical procedures

The procedure can be performed under general anesthesia (the patient is asleep) or under local anesthesia (using drugs such as novocaine that numb the arm), or a combination of both.
During the operation, the patient can lie on his back, on his side or on his stomach.
If the patient lies on his stomach, the face may still be swollen for a few hours after the end of the operation.
This effect is perfectly normal and only temporary.

The broken bones are joined together and held in place with a construction of plates and screws.
Usually, the surgeon makes an incision on the shoulder to get to the broken bone.
There are several ways to hold the bone fragments in position.

The surgeon has the following options:

  • Kirschner wires (flexible metal wires),
  • Screw
  • plates and screws,
  • sutures on the bone or tendons,
  • a combination of the above methods.

As a rule, the incision is closed with seams or staples.
Sometimes the surgeon decides to splint the arm to take the tension off the incision.
Some fractures may require special measures during the procedure.

Bone loss. If bone fragments are missing or have been crushed (pieces of bone lost due to an accident), a bone graft may be necessary in addition to restoration. The transplant can be performed by a patient’s own piece of bone (usually taken from the pelvis or fibula), with bone from a donor bank or with artificial, calcareous material.

Surgical complications of a shoulder fracture

There are some risks associated with the operation.
If the doctor advises surgery, it can be assumed that the possible benefit of the procedure is greater than the risks.

There is a risk of infection with any surgery, whether it is a shoulder fracture or other type of surgical procedure.

Postoperative pain
In the operating room, the pain is kept under control by a team of anesthesiologists who can anesthetize the patient or numb only the arm.
The doctor talks to the patient about the type of anesthesia before surgery.
After surgery, pain is relieved with a combination of painkillers such as morphine, codeine and acetaminophen.

Damage to nerves
and blood vessels 
There is a small risk of damage to nerves and blood vessels in the shoulder area. This would be an unusual side effect.

The ulnar nerve is shifted during surgery and usually recovers spontaneously. Temporarily, numbness or weakness may occur in the area, which may not pass until weeks or months later. In rare cases, the nerve may be injured during surgery. This may require further surgery to help the nerve heal.

Insufficient consolidation
The operation cannot guarantee the healing of the fracture.
A fragment could come loose or the screws, plates and wires could shift or break.
This can happen for a number of reasons, including:

  • The patient did not follow the instructions after the operation.
  • The patient has other health problems that slow healing. Some conditions, such as diabetes, can stop the process. Smoking and the consumption of other tobacco products can also delay bone consolidation.
  • If it is an open fracture (with an injury to the skin), the healing process usually takes longer.
  • Infections can delay or prevent consolidation.

If the fracture does not grow together, further surgery may be required.

Prognosis for a shoulder fracture

Patients with a humeral fracture usually achieve complete recovery under appropriate therapy (either surgical or conservative).
Returning to work or sports may be possible after a certain number of weeks or even many months after the accident.
The doctor or physiotherapist should teach the patient rehabilitation exercises and perform passive mobilization for the restoration of possible mobility.

In patients with severe injuries that affect other bones, soft tissues, nerves or blood vessels, the recovery time can be significantly extended.
Patients with mild or undisplaced fractures (mini-fracture) can usually resume sports after 6-8 weeks, depending on the opinion of the personal physiotherapist.
In the case of a postponed fracture, recovery times are much longer and can range from 3 to 6 months.
Older people with upper arm fractures usually do not fully regain mobility when lifting the arm, but can dress and comb.
Full mobility is not necessary to carry out everyday activities.

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