The clavicle lies directly underneath the skin and is one of the most common bones in the human body that is fractured. It connects the sternum with the scapula and is attached to these bones by strong ligaments. Most of the fractures take place in the middle third, followed by fractures towards the shoulder side and least often fractures towards the sternum side.
Clavicle fractures usually occur when a person falls directly on the shoulder or through direct impact over the clavicle like in a motor vehicle accident or sports injuries. The clavicle of a baby can also be broken as it is delivered through the birth canal.
Clavicle fractures are usually very painful with local swelling and tenderness and inability to move the shoulder or arm. Bruising may occur and often a knob might be palpable under the skin and might sometimes even being seen. A slip or crack feeling might be experienced during shoulder movements.
The location of the fracture, displacement thereof and whether other structures are involved will influence the classification. Comminution of the fracture and whether the skin is lacerated are also taken into account.
Where there is no displacement of the clavicle fracture, most of them are treated with a sling until healing takes place. Where there is wide displacement or non-union, surgical repair might be indicated. Procedures differ according to the grade and the area of the fracture, but usually involve instrumentation by which the bone is aligned and fixed until bony union occurs.
The humerus is the long bone of the arm that is the bony link between the shoulder and the elbow. Fractures of the humerus in the vicinity of the shoulder is called proximal humeral fractures and involves the humeral head, the anatomical neck, the surgical neck and the areas in between which is called the tuberosities. Proximal humeral fractures are of the more common fractures in the human body.
In elderly persons proximal humeral fractures are more common. Weakening of the bone due to osteoporosis increases the possibility of fractures of the proximal humerus during a fall especially when the person lands on an outstretched arm or directly on the shoulder. Other humeral fractures might occur during direct impact over the arm for instance during a collision like in a motor vehicle accident.
These fractures are often severely painful and cause a lot of swelling and bruising around the fracture. In severe cases deformity is present around the fracture area and movement of the arm is usually severely limited due to pain.
Fracture classification involves the location, the amount of communition, which parts of the involved bone or joint is fractured and associated injury of soft tissue structures. It also takes into account whether dislocation of the joint is present or not.
The decision of what to do with proximal humerus fractures depends on where it has taken place, whether it is displaced and whether rotator cuff attachment is involved in the fracture. Undisplaced fractures can be treated with a sling and early range of motion exercises while the bone is busy healing. Severely displaced fractures might need surgery which involves the careful rejoining and fixation of the fragments with instrumentation. In some cases a part of the bone has to be removed and replaced with a prosthesis. The attachments of the rotator cuff are very important and usually a lot of attention is given to the careful fixation of these parts in order to restore shoulder movement in the long run as good as possible.
The shoulder blade, or scapula, forms together with the humerus and clavicle the shoulder joint to which the shoulder girdle muscles attach. The lateral end of the scapular neck, called the glenoid fossa, forms the cup part of the shoulder's ball and socket joint. The scapula is protected by the overlying muscle of the shoulder, back and thorax. Scapular fractures are not common. When they do occur it is usually through high energy trauma directly over the scapular area and can be associated with rib fractures. Different parts can be individually or simultaneously involved during a fracture. Fracture of the glenoid involves the glenohumeral joint and can be more often associated with joint complications.
High energy trauma is the most common cause of scapular fractures, like falling from a height or in motor vehicle accidents. Associated rib, lung, head, humerus and vertebral injuries can occur.
It depends on the specific area where the fracture has taken place, but usually involves pain, swelling and limitation of movement of the arm. There is also local tenderness and in severe cases dislocation of the shoulder joint.
There is different classifications that can be followed. In general, classification takes into account which part is involved in the fracture, the fracture pattern and whether the fracture is in combination with other injuries. Multiple fractures are common with scapular injury.
Depending on the extent and the location of the fracture, treatment will differ. Most scapular fractures heal well without intervention and are treated with a sling, early mobilizing, exercises and pain relief. When the significant part of the glenoid is involved, reconstruction of the scapular is necessary. When the skin is penetrated, surgery is also indicated. Surgery usually requires instrumentation to stabilise fracture in a good position until it has healed.