Shoulder fractures involve at least one of the three shoulder bones: scapula (omóplato), The clavicle (clavicle) or humerus (upper arm bone). All three types of fractures can cause shoulder pain, swelling, sensitivity and limiting the range of motion of the shoulder, but there are also significant differences.
Most shoulder fractures are successfully treated without surgery. Non-surgical treatment is an option when the bones are not displaced, which means that the bones remain in their correct anatomical positions. About the 80% of shoulder fractures do not move.
Conversely, a shoulder fracture is described as displaced when pieces of broken bone separate and are no longer in their correct anatomical position. Displaced fractures may require surgery to realign the bones to heal in their precise positions..
Traumatismo del hombro (fracturas y luxaciones)
El trauma en el hombro es común. Las lesiones van desde un hombro separado como resultado de una caída sobre el hombro hasta un accidente automovilístico a alta velocidad que fractura el omóplato (escápula) o la clavícula (clavícula). Una cosa es segura: todo el mundo se lastima el hombro en algún momento de la vida.
El hombro está formado por tres huesos:
Estos huesos están unidos por tejidos blandos (ligamentos, tendones, músculos y cápsula articular) para formar una plataforma para que funcione el brazo.
El hombro está formado por tres articulaciones:
El hombro también tiene una articulación, que es la relación entre la escápula (omóplato) y la pared torácica.
La articulación principal del hombro es la articulación glenohumeral. Esta articulación consta de una bola (la cabeza humeral) en una articulación en forma de tee de golf (la glenoides de la escápula).
Los huesos del hombro están cubiertos por varias capas de tejidos blandos.
Hay muchos tipos de lesiones en el hombro:
The shoulder is made up of a group of bones that work together to allow the shoulder and arm to function.. The shoulder bones include the upper arm bone (humerus), The clavicle (clavicle) and the shoulder blade (scapula). The shoulder includes the glenohumeral joint (ball joint), acromioclavicular joint and sternoclavicular joint.
A fracture of any of the shoulder bones can greatly affect your mobility and cause severe pain.. Shoulder fractures occur as a result of trauma or injury to the shoulder from a fall, sports injury, car accident or any direct blow to the shoulder. Penn orthopedic specialists treat all types of shoulder fractures using the latest diagnostic and treatment techniques that offer the best possible results..
Most clavicle fractures can be treated without surgery. Surgery is necessary when there is a compound fracture that has gone through the skin or the bone is seriously out of place. Surgery generally involves fixation of the fracture with plates and screws or rods within the bone..
Most proximal humerus fractures can be treated without surgery if the bone fragments are not displaced out of position. (displaced). If the fragments move out of position, surgery is usually required. In general, surgery involves fixation of the fracture fragments with plates, screws or dowels or involves a shoulder replacement.
Most scapula fractures can be treated without surgery. Treatment involves immobilization with a shoulder sling or immobilizer, ice and pain relievers. The patient will be examined for additional injuries.
About 10% al 20% of scapula fractures need surgery. Fractures that need surgery usually have fracture fragments involving the shoulder joint or there is an additional fracture of the clavicle. Surgery involves fixation of the fracture fragments with plates and screws.
The shoulder joint is a ball joint. A ball’ at the top of the upper arm bone (humerus) fits perfectly in a 'cavity', called glenoids, what is part of the shoulder blade (scapula).
A fracture is a break in the bone that commonly occurs as a result of injury., like a fall or a direct hit to the shoulder. A fracture of the upper arm (proximal humerus) is more common in older people with osteoporosis. In younger individuals, high energy trauma is usually required to cause these fractures.
Proximal humerus fractures can be classified into 4 groups:
• Greater tuberosity fractures: the greater tuberosity is the insertion site for the attachment of the rotator cuff tendons. Greater tuberosity fractures are less common and are seen in cases of shoulder dislocations and in people with osteoporosis.
• Surgical neck fractures: surgical neck fractures are more common in patients with osteoporotic bone.
• Lesser tuberosity fractures: these fractures are rare. If not treated, these fractures lead to loss of function of the subscapularis muscle (a stabilizing and mobilizing muscle).
• Humeral head fractures: humeral head fractures are rare.
Another way to describe proximal humerus fractures is by counting the number of displaced fracture fragments. (fractures of two, three and four parts). The greater the fragmentation of the proximal humerus, the greater the risk of long-term loss of blood supply to the bone that supports the bone. humeral head (necrosis avascular).
Patients with proximal humerus fractures experience pain, sleep disturbances, swelling and restriction of movement of the shoulder. Bruises can spread through the chest wall and down the arm.
Proximal humerus fractures are diagnosed by history, physical examination and imaging of the affected area (radiography and / or CT scan (TC)).
Most proximal humerus fractures have minimal displacement and can be treated nonoperatively.. This involves using a sling to immobilize the arm and then physical therapy to restore function.. Surgery may be necessary for displaced fractures. Multiple fragments are fixed with plates, screws or a joint replacement.
The shoulder is a complex and sophisticated joint. It is made up of three bones: scapula (omóplato), humerus (upper arm bone) and the clavicle (clavicle); all are surrounded by a series of muscles, ligaments and tendons. Its complex structure allows a full range of motion to place the arms and hands in a variety of positions. It is the most mobile joint in the body, but it is also one of the most potentially unstable joints, making you vulnerable to injury and shoulder problems.
Trauma to the shoulder from a fall on an outstretched arm is one of the common causes of shoulder pain.. When people fall, they usually try to hold on with their hands as they fall, allowing the energy of the fall to be transmitted from the arm to the shoulder. Other causes of fracture-related shoulder pain include sports accidents or car accidents.
A fractured shoulder is often called a "broken shoulder.". A fracture can be described as displaced or undisplaced. An undisplaced shoulder fracture means that the broken pieces remain close to their anatomical position.. A displaced shoulder fracture often requires some type of procedure to restore the shoulder to its normal anatomy..
Types of shoulder fractures include a proximal humerus fracture, a fractured scapula and a fractured clavicle.
If the bones are displaced or there is an open fracture (where the bone has pierced the skin), surgery is needed to repair the fracture and ligaments, damaged tendons and muscles. To relock the bones in the correct position, orthopedic surgeons will use specialized hardware, like plates, screws or dowels. In some cases, surgeons will perform bone grafts and repair soft tissues such as ligaments and tendons. In some cases of severe fractures, the shoulder will require a joint replacement.
If you have a severe shoulder fracture, you may need a partial shoulder replacement. For this procedure, a conventional shoulder replacement device, composed of a ball and a metal stem, replace damaged ball and upper arm bone. People who receive a partial shoulder replacement experience less pain, better performance and greater range of motion allowing a better quality of life.
In some cases, a severe shoulder fracture will require a reverse total shoulder replacement. In a total reverse shoulder replacement, the cavity and the metal ball are changed: the metal ball is attached to the socket and the plastic cup is attached to the humerus. People who undergo a reverse total shoulder replacement experience reduced pain and improved function and range of motion.
A nonunion is a broken bone that did not heal properly. A bad union is a broken bone that has healed in the wrong position, which often causes a deformity. Treatment may include surgery to remove an infection. (if present), to better stabilize the fracture or to stimulate bone growth with a bone graft. Our orthopedic surgeons work closely with specialists to repair the most complex cases of malunion and pseudarthrosis..
Penn orthopedic surgeons perform complex nonunion surgical repair with vascularized bone graft. Vascularized bone grafts allow live bone tissue to be transplanted to replace damaged bone tissue.
A shoulder fracture can result from a fall on the shoulder, a car accident, contact sports, etc.
The shoulder is a complex joint that connects the arm to the body. The bones of the shoulder include the humerus (upper arm bone), scapula (omóplato) and the clavicle (clavicle) (Figure 1). The upper end of the humerus is shaped like a ball that connects to the socket of the scapula, called glenoids. Breaking any part of the shoulder can create difficulties with its function..
The type of shoulder fracture varies by age. Most fractures in children occur in the clavicle bone. In adults, the most common fracture is the upper humerus (proximal humerus). Some types include:
Some fractures are diagnosed by X-ray. Sometimes, a CT scan is needed to see more details.
Trauma can cause a humerus fracture (she was) o la glenoides (cavity) of the shoulder joint. Most of these injuries can be treated without surgery with good long-term results.. Some fractures are best treated with surgery because they can carry a high risk of arthritis if left alone. Some are unlikely to be cured, or they may heal in the wrong position if not treated surgically.
Fractures are described as displaced or undisplaced. Fortunately, almost the 80 percent of all shoulder fractures do not displace. This implies that the broken pieces remain close to their anatomical position and treatment only requires immobilization in a sling until the bone fragments heal.. Most shoulder fractures heal in about six weeks. Around the 20 percent of shoulder fractures are displaced and may require some manipulation to restore normal anatomy.
Occasionally, the rotator cuff muscles are injured or torn at the same time as the fracture. This can further complicate treatment..
The shoulders are among the most complicated joints in your body because they allow you to move your arm, Back and forth, and from side to side. As a result, a shoulder fracture can have a serious effect on your daily life. The shoulder is the glenohumeral joint; is where the upper part of the humerus (the bone of the upper arm) fits into the cavity of the scapula (omóplato). A fractured or broken shoulder, most often describes a break in the clavicle (clavicle), the proximal humerus (top of humerus closest to scapula) or on the scapula itself.
The most common type of shoulder fracture is a broken clavicle, more often due to fall. Proximal humerus fractures most commonly affect older people, and scapula fracture is the least common of the three main types of fracture. . Most fractured shoulders are undisplaced fractures, where the bone is broken but the pieces haven't moved. A displaced fracture means that the ends of the broken bone have moved out of place. Undisplaced fractures are easier to treat and usually heal more quickly than displaced fractures..
Shoulder fractures can be quite painful, although they will not always be invalidating. Some of the symptoms associated with them are:
As the name suggests, These are plates that are fixed to the bone with screws, stabilizing it throughout the healing process. Evidently, for its implantation it is necessary to make incisions in the skin and the surrounding soft tissues, so it is an open procedure.
They place special emphasis on the anatomical reduction of the fragments, trying to properly reduce the tuberosities, return retroversion to the head and restore bone length.
They are usually used in fractures of greater complexity or when the functional demands of the patient are going to be high. However, they may not be recommended in cases where necrosis is suspected (death due to lack of blood supply) of the humeral head.
Until a few years ago, intramedullary nails were reserved for shaft fractures of the humerus. However, In recent times, specific nails have been designed that maintain a high degree of stability in fractures of the proximal humerus.. Their fundamental advantage is that they are devices that can be implanted in a minimally invasive way., with reduced damage to the vascularisation or the periosteum.
The main weakness of the nail is that it does not allow as precise a reduction as the plates and that, in complex fractures, does not offer good support of the tuberosities. Nevertheless, can be a good solution for simple fractures (for example, two-fragment fractures of the surgical neck) or for those with great metaphyseal extension.
One of the most severe complications of proximal humerus fractures is necrosis of the femoral head.. It is possible that the head "dies" due to lack of blood supply and this causes a degeneration of the area even if a good fixation of the fracture has been made.
Thus, many orthopedists use prostheses to treat fracture cases in which avascular necrosis is expected to occur. Specifically, prosthetic replacement is often indicated in complex fractures (three and four fragments) or in joint fractures (severed or sunken head with involvement of more than one 40% Of the surface).
The most obvious symptom of a fractured shoulder, either a fractured scapula or one of the other bones, it's the pain. Shoulder fracture pain is often severe. Other common shoulder symptoms include:
A fractured shoulder is a medical emergency. Some shoulder fractures require surgery to allow the shoulder to heal properly.. If surgery is not necessary, a doctor will put a shoulder fracture sling on you. The sling will stabilize your arm and help keep the bones aligned for proper healing.
This is often affected by the severity of your original injury.. You may need help dressing, bath, wash and eat for five to 10 days. We will make sure you have adequate amounts of pain relievers to make you comfortable.
Your doctor will examine you and evaluate your X-rays to determine your progress.. Your return to work will be earlier for a desk job and later for work-related occupations.
The most common cause of a shoulder fracture is a fall directly onto the upper arm and shoulder. You can also break your shoulder in a collision, how an athlete may experience when playing contact sports or a car accident. Scapula fractures are the least common of shoulder fractures because the bone is protected by the muscles of the back.. A direct blow to the area is the most common cause of a scapula fracture..
Physical therapy is often required to benefit movement and strength to maximize recovery and improve outcome. Your doctor and your therapist will work together and advise you when to progress in your activities and exercises..
A fracture in one of the bones that make up the shoulder is the result of some type of trauma, But there are some risk factors that can increase your risk of breaking your shoulder.. Include:
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Doctor Danilo Velandia León Specialist with experience in Orthopedics and Traumatology, Knee Surgery and Shoulder Surgery, which includes prevention, diagnosis, surgical and non-surgical treatment and monitoring of all conditions of the musculoskeletal system and its associated structures (bones, joints, ligaments, tendons, muscles and nerves)
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