Fractures and Dislocations

Fractures (broken bone) of the shoulder have a bimodal incidence. They are either seen in the young athletic patient groups (from a high energy injury) or in the older age group (from a relatively trivial fall). The higher energy injuries are often associated with associated injuries which may take precedence in initial management of the patient.

Clavicle (collar bone) fractures are one of the most common upper limb injuries seen in children and the youth. Although the vast majority heal well to produce excellent outcomes with non operative methods, an important subgroup needs surgical management. Proximal humeral fractures (breaks of the upper end of the arm bone) are most commonly seen in the older age group from a relatively small injury. A majority of these injuries, again, don't need surgical treatment but a selected proportion of these do better with surgery. Fractures of the scapula (shoulder blade) are the not as common and usually occur following a higher energy. It is frequently necessary to assess these fractures with advanced imaging such as a CT scan to determine the best course of treatment

Dislocation of the shoulder is extremely common and is in-fact the price this joint has to pay for being the most mobile joint of the body! To allow for such a good range of movement, over the evolutionary process, the shoulder has evolved into a joint with large ball (humeral head) and a relatively small socket (glenoid part of the shoulder blade). The ability of the hand to reach in a 3 dimensional hemisphere along with the ability to throw has been one of key factors leading the human beings to reach the top of the evolutionary tree. This, however, also means that the shoulder is also the most common joint of the body which is liable to dislocate. Contact sports, such as Rugby, are by the most common reasons leading to such an injury. The humeral head may dislocate to the front (anterior), back (posterior) and rarely downwards (inferiorly).

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