Proximal humeral fractures most commonly occur in which scenarios?
- Fall onto outstretched hand
- Fall directly onto shoulder
What is the most common pattern of humeral neck fracture?
What is the main reason the humeral shaft is displaced in proximal humeral fractures?
Pull of the pectoralis major
Persistantly displaced humeral neck fractures are usually treated in which way?
(plate, screws, wires or intra-medullary nail)
What are some potentially negative outcomes of internal fixation of proximal humeral shaft fractures in the older patient?
- Chronic pain
- Failure of fixation
When would a shoulder replacement be considered in a proximal humeral fracture?
If there is a 3 or 4 part comminuted humal fracture
(the humeral head may undergo AVN otherwise)
Head splitting fractures of the humerus usually require what type of treatment?
(unless the patient is young with very good bone quality)
Anterior shoulder dislocation is much _____ __________ than posterior shoulder dislocation
Anterior shoulder dislocation is much more common than posterior shoulder dislocation
Why may anterior shoulder dislocations occur?
- Excessive external rotational force
- Fall onto back of shoulder
Anterior shoulder dislocations usually result in detachment of the anterior glenoid labrum and capsule.
What is this called?
What happens when the posterior humeral head impacts the naterior glenoid?
What is a Hill-Sachs lesion?
Impactation fracture of posterior humeral head
Which nerve is particularly at risk during an anterior shoulder dislocation?
What is the principle sign of axillary nerve damage?
Loss of sensation in the regimental badge area
Shoulder dislocation occurs commonly alongside which two types of fracture?
- Fracture of surgical neck of humerus
- Fracture of greater tuberosity of humerus
What is the mainstay of treatment for shoulder dislocations?
- Closed reductuion under anaesthetic
- Sling for 2-3 weeks
What causes a posterior shoulder dislocation?
Posterior force on adducted and internally rotated arm
What is the main X-ray finding for a posterior shoulder dislocation?
Light bulb sign
What happens in an AC joint subluxation?
The AC ligaments are ruptured
What happens in AC joint dislocation?
- Coracoclavicular ligaments (conoid and trapezoid) are ruptured
- AC ligaments are ruptured
How can AC joint injuries be treated?
- Sling for a few weeks
- Surgery for chronic pain (coracoclavicular ligaments are reconstructed)
(surgery may be attempted sooner for young athletes)