Fx of the Shoulder

Question 1

Clavicle Fx

Answer 1

80% occur at middle third
15% lateral
5% medial

Question 2

What is the common site of clavicle fx and what does it result in?

Answer 2

middle third

results in bayonet apposition

Question 3

Etiology of Clavicle Fx

Answer 3

trauma - fall
pathologic - bone
cyst

Question 4

What type of clavicle fx require surgery?

Answer 4

1. distal clavicle fx near the AC joint
   because of the impingement on the rotator
   cuff
2. communition fx

surgery can use plates

Question 5

Tx of most clavicle fx

Answer 5

SLING

Question 6

Fx of clavicle can occur from underlying diseases

Answer 6

infection or bone tumor

Question 7

Distal Clavicle fx

Answer 7

post traumatic can lead to arthritis - joint problem

Question 8

What is the tx goal for clavicle fx?

Answer 8

restore length

use clavicle strap - unpopular (patient compliance is low)

Question 9

PROXIMAL clavicle fx

Answer 9

require surgery

hard to replace it back into original place

Question 10

Complications of clavicle fx

Answer 10

1. nonunion when done surgery (won’t heal)
2. pneumothorax - the more communiuted the more likely chance of pneumothorax
3. subclavian a injury
   more sublux of the clavicle the more chance of injury for subclav a.

Question 11

Fx of the scapula

Answer 11

body
neck
glenoid
acromion

Question 12

If glenoid of the scapula fx, how to tx?

Answer 12

if displaced or intra-articular

need surgical management

Question 13

Mechanism of injury of scapula fx

Answer 13

direct trauma

FOOSH

Question 14

Fx of humerus

Answer 14

Head
Surgical neck
anatomic neck
proximal shaft

Question 15

How to tx fx of humerus

Answer 15

No surgery
wait 3 wks after putting a sling
multiple portions of the scapula in involved

STABILIZE

Question 16

CODMAN described the proximal humeral fx

Answer 16

Proximal humeral fractures

adults occur along the lines of the old physeal scars

Question 17

The 4 anatomic parts of the proximal humerus fx

Answer 17

greater tuberosity
lesser tuberosity
humeral head
humeral diaphysis (shift)

Question 18

How common is the proximal humerus fx?

Answer 18

more common than hip
4-5% of all fx
affects women more than men = a typical patient is a elderly woman who falls (osteoporosis)

Question 19

What are the majority of the proximal humerus fx?

Answer 19

nondisplaced fx (still has anatomic alignment)

Question 20

Neer classification of proximal humerus fx

Answer 20

One part - impacted compression
Two part - greater tuberosity fx
Three part - head separates from the greater tuberosity and shaft
Four part- head , tuberosities, and shaft separate

Question 21

one part fx

Answer 21

compression - impacted

Question 22

two part

Answer 22

greater tub. fx

Question 23

three part

Answer 23

greater tub and head fx

Question 24

four part

Answer 24

greater tub less tub and head fx

Question 25

if greater tub. fx what is at risk

Answer 25

rotator cuff pulled off displaced

Question 26

AVN = avascular necrosis of the head of the humerus

Answer 26

result from four part fx | won't heal

Question 27

Etiology of proximal humerus fx

Answer 27

FOOSH | decreased abduction

Question 28

What vessels are destroyed in 4-part fx

Answer 28

anterior and posterior humeral circumflex a.

Question 29

Tx of one part

Answer 29

``` non surgical 1-3 immobilization sling pendulum exercises elbow ROM ```

Question 30

Tx of two part

Answer 30

surgical neck is fx REDUCED CLOED AND IMPACTED open reduction internal fixation can be okay if unstable

Question 31

Tx of three part

Answer 31

Use ORIF if greater than 5 mm displacement for greater tuberosity and suture fixation for lesser tuberosity but this is rare

Question 32

ORIF

Answer 32

``` open the skin, put it back in place by plates and screws cement it for elderly used for three part fx (usually) both the tuberosities will heal use wire and suture ```

Question 33

Tx 4 part

Answer 33

generally ORIF doesn't work because the head will collapse down and AVN won't let it heal properly AVN prosthesis is the best tx

Question 34

Prosthesis of the humerus

Answer 34

replace the humerus | need tuberosities for motions