FRACTURES ABOUT THE SHOULDER: Conservative Management

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Fractures about the shoulder are common occurrences. Of the three bones in the shoulder region, the clavicle is most often broken followed by the proximal humerus and less commonly the scapula. Each of these bones is unique in its fracture patterns and mechanism of injury. A thorough history and physical examination along with selective radiographs can lead to an accurate diagnosis and appropriate treatment plan. Most of these fractures may be treated conservatively with good functional results.

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FRACTURES OF THE CLAVICLE

The clavicle is the most commonly fractured bone during childhood, and it has been estimated that it is involved in 1 of every 20 fractures in adults.2 It is almost entirely subcutaneous along its anterior course and is exposed to a variety of traumatic insults, including motor vehicle accidents, sports injuries, and falls. Fractures of the clavicle easily are diagnosed, and most can be managed by conservative, closed means. Complications are rarely encountered, and clavicle fractures unite

PROXIMAL HUMERUS FRACTURES

Most proximal humeral fractures occur in the elderly, but in young adults, these injuries are primarily caused by high-energy trauma. Overall, approximately 85% of proximal humeral fractures can be treated without surgery with successful results. An understanding of the anatomy, muscle forces around the shoulder, classification, and treatment options is essential in providing proper care to each patient with a proximal humerus fracture.

SCAPULA FRACTURES

Fractures of the scapula are uncommon, accounting for only 3% to 5% of shoulder girdle injuries7, 44 and less than 1% of all fractures.37, 52 The rarity of this injury is likely due to the great mobility of the scapula coupled with the fact that it is well protected by layers of muscle. Scapula fractures commonly occur from direct trauma involving considerable violence. Most studies report a male predominance of scapular fractures with an average age of 35 to 45.45 The significant trauma

SUMMARY

Fractures about the shoulder may occur in patients of all ages from high-energy and low-energy trauma. Orthopedic surgeons must know the anatomy of these bones, their muscular attachments, and proximity of neurovascular structures to provide appropriate treatment. A thorough history and physical examination identify most of these fractures. Selective radiographs of each bone assist the surgeon in classifying the fracture and developing a treatment plan. One must always bear in mind the

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    Address reprint requests to Brodie E. McKoy, MD, Department of Orthopaedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425

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    Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina

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