Shoulder Fractures and Dislocations

Question 1

Proximal humeral fractures most commonly occur in which scenarios?

Answer 1

1. Fall onto outstretched hand
2. Fall directly onto shoulder

Question 2

What is the most common pattern of humeral neck fracture?

Answer 2

Surgical neck

Question 3

What is the main reason the humeral shaft is displaced in proximal humeral fractures?

Answer 3

Pull of the pectoralis major

Question 4

Persistantly displaced humeral neck fractures are usually treated in which way?

Answer 4

Internal fixation

(plate, screws, wires or intra-medullary nail)

Question 5

What are some potentially negative outcomes of internal fixation of proximal humeral shaft fractures in the older patient?

Answer 5

1. Stiffness
2. Chronic pain
3. Failure of fixation

Question 6

When would a shoulder replacement be considered in a proximal humeral fracture?

Answer 6

If there is a 3 or 4 part comminuted humal fracture

(the humeral head may undergo AVN otherwise)

Question 7

Head splitting fractures of the humerus usually require what type of treatment?

Answer 7

Shoulder replacement

(unless the patient is young with very good bone quality)

Question 8

Anterior shoulder dislocation is much _____ __________ than posterior shoulder dislocation

Answer 8

Anterior shoulder dislocation is much more common than posterior shoulder dislocation

Question 9

Why may anterior shoulder dislocations occur?

Answer 9

1. Excessive external rotational force
2. Fall onto back of shoulder

Question 10

Anterior shoulder dislocations usually result in detachment of the anterior glenoid labrum and capsule.

What is this called?

Answer 10

Bankart lesion

Question 11

What happens when the posterior humeral head impacts the naterior glenoid?

Answer 11

Hill-Sachs lesion

Question 12

What is a Hill-Sachs lesion?

Answer 12

Impactation fracture of posterior humeral head

Question 13

Which nerve is particularly at risk during an anterior shoulder dislocation?

Answer 13

Axillary nerve

Question 14

What is the principle sign of axillary nerve damage?

Answer 14

Loss of sensation in the regimental badge area

Question 15

Shoulder dislocation occurs commonly alongside which two types of fracture?

Answer 15

1. Fracture of surgical neck of humerus
2. Fracture of greater tuberosity of humerus

Question 16

What is the mainstay of treatment for shoulder dislocations?

Answer 16

1. Closed reductuion under anaesthetic
2. Sling for 2-3 weeks

Question 17

What causes a posterior shoulder dislocation?

Answer 17

Posterior force on adducted and internally rotated arm

Question 18

What is the main X-ray finding for a posterior shoulder dislocation?

Answer 18

Light bulb sign

Question 19

What happens in an AC joint subluxation?

Answer 19

The AC ligaments are ruptured

Question 20

What happens in AC joint dislocation?

Answer 20

1. Coracoclavicular ligaments (conoid and trapezoid) are ruptured
2. AC ligaments are ruptured

Question 21

How can AC joint injuries be treated?

Answer 21

1. Sling for a few weeks
2. Physio
3. Surgery for chronic pain (coracoclavicular ligaments are reconstructed)

(surgery may be attempted sooner for young athletes)