Fracture
What is a Fracture?
A shoulder fracture involves a break in one of the bones that make up the shoulder joint, commonly the clavicle (collarbone), scapula (shoulder blade), or humerus (upper arm bone).
Types of Shoulder Fractures:
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Clavicle Fracture: The most common shoulder fracture, often resulting from a fall directly onto the shoulder or an outstretched hand.
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Proximal Humerus Fracture: A break near the top of the upper arm bone, common in older adults due to osteoporosis or in younger people from high-impact injuries.
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Scapula Fracture: Less common and usually caused by high-energy trauma like a car accident or a fall from a height.
Mechanism of Injury:
Shoulder fractures are typically caused by direct trauma such as a fall, sports injury, or car accident. The specific bone that breaks depends on the direction and force of the impact.
Symptoms
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Severe Pain: Intense pain at the site of the fracture, especially with arm movement.
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Swelling and Bruising: Rapid swelling and discolouration around the shoulder.
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Deformity: Visible or palpable abnormality at the fracture site, particularly with clavicle fractures.
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Limited Range of Motion: Inability to move the shoulder or arm without significant pain.
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Crepitus: A grinding sensation or sound with shoulder movement.
Treatment
Immediate Treatment:
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Immobilisation: Use of a sling or shoulder immobiliser to prevent movement and protect the fracture.
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Ice: Applied to reduce swelling and pain.
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Pain Relief: NSAIDs like ibuprofen or prescribed pain medication.
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X-Rays and Imaging: To confirm the fracture type and determine the appropriate treatment plan.
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Physiotherapy: Initially focuses on gentle range of motion exercises to prevent stiffness. As healing progresses, strengthening exercises are introduced to restore function.
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Bone Healing Aids: Supplements like calcium and vitamin D may be recommended to support bone healing.
Surgical Treatment:
Surgery may be necessary for fractures that are severely displaced, involve multiple fragments, or do not heal properly with conservative treatment. Surgical options include:
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Open Reduction and Internal Fixation (ORIF): Realignment of the bones with plates, screws, or rods to stabilise the fracture.
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Shoulder Replacement: In cases of severe fractures, especially in older adults, part or all of the shoulder joint may be replaced.
Post-surgery, a rehabilitation programme in the clinic is crucial to regain shoulder strength and mobility, involving progressive physiotherapy tailored to the healing stage.