Shoulder Fracture

• Pain
• Swelling and bruising
• Tenderness
• Restricted motion
• Instability
• Deformity at the site of the break

Shoulder fractures are the result of trauma from a fall, an auto accident, a collision, a shoulder dislocation, or a direct hit to the shoulder during contact sports.  Trauma can cause complex injuries to the bones and soft tissues in the shoulder, and result in instability and diminished function.

Dr. Petrigliano will review your medical history, discuss the cause of your injury, and conduct a physical exam testing range of motion and tenderness. He will order X-rays to evaluate the bones and a CT scan to view the fracture in detail to establish severity and to identify all soft tissue damage. This is necessary for accurate diagnosis and creation of a treatment plan to care for the injuries.

A displaced fracture is where the bone breaks into 2 or more pieces that do not line up straight. When a fracture is displaced, it needs to be put back into alignment. This is called a reduction. A closed reduction is where the pieces can be aligned so that the broken ends can grow back together.  An open reduction is surgery to line up the pieces of the bone so it can heal.

Most shoulder fractures are not displaced and can be treated without surgery, unless there are associated injuries to the rotator cuff, muscles, ligaments, and tendons and/or the articular surfaces of the shoulder bones.

Most non-displaced shoulder fractures can be successfully treated with conservative measures including:

• Immobilization with a sling or brace to allow the bones to heal
• Icing to reduce pain and swelling
• Pain medications
• Physical therapy 

• A clavicle fracture is a broken collarbone. It is the most common fracture in children and young adults but accounts for about 5% of all adult fractures. It is often caused by a fall on to the shoulder or on an outstretched arm, or from an auto accident. Symptoms include pain, swelling, and bruising, a sagging shoulder, pain that impairs the ability to lift the arm, and a deformity over the break. Most can be treated with conservative measures including a sling. Complicated clavicle fractures where the bones are out of alignment or where the fracture heals poorly (malunion) may require surgery to realign the bones.
• A proximal humerus fracture is a fracture of the head of upper part of the arm. Proximal humerus fractures are common in older adults, especially those with osteoporosis. They are more common in women. They are usually caused by a fall at ground level on an outstretched arm. The break is at or near the ball of the shoulder joint. Most can heal without surgery with sling immobilization and physical therapy. Surgical fixation is necessary for displaced fractures and shoulder replacement (arthroplasty) may be indicated in complex cases.
• A fracture of the shoulder socket is rare and is usually the result of a shoulder dislocation from high energy trauma or fall from a roof or high place but can also be caused by a sports injury. The labrum or articular cartilage can be damaged and cause instability. Symptoms include severe pain and swelling. Sling immobilization holds the bones in place during healing. Some scapula fractures will require surgery.
• A Hill – Sachs defect is an injury secondary to a shoulder dislocation that causes a compression fracture of the upper arm bone. This defect stretches the soft tissues and can cause recurrent dislocations. It may be caused by a sports injury. If the defect is small, it may be treated conservatively. However, large lesions may require surgery.
• A Bony Bankart is an injury to the labrum that also breaks off part of the glenoid bone (a glenoid rim fracture). It is often caused by a traumatic shoulder dislocation. Most of these fractures are small and can be treated non-operatively. However, a large bony Bankart is associated with recurrent instability. Surgery is the gold standard treatment for large lesions.

The goal of surgery is to restore function, range of motion and strength to allow patients to regain the ability to perform the activities of daily life.

When there are complex fractures and injuries of the soft tissue, surgery will be necessary and may be done in stages. Displaced and open fractures will require fixation with pins, screws, and plates to restore bone alignment.  Sometimes a bone graft may be needed. Repair of associated soft tissue injuries may be accomplished along with fixation. In some cases, the fracture may be so severe as to require a shoulder replacement. Physical therapy is essential to full recovery.