[Immobilization of the shoulder girdle and the wrist with special reference to fractures of the clavicle and the scaphoid bone].
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Child↗
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Results for “SHOULDER FRACTURES”
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Bilateral fractured clavicles--a pair of cases.
The authors present two cases of bilateral fractured clavicles, both resulting from direct trauma to both shoulders. In both cases, the fractures healed uneventfully with non-operative treatment.
Accidents, Traffic↗
The rate of recurrence of traumatic anterior dislocation of the shoulder. A study of 154 cases and a review of the literature.
We have reviewed the history of 154 primary, traumatic dislocations of the shoulder in order to determine the risk of recurrence. We found a recurrence rate of 68% in patients under the age of 20, after a follow-up period of 1-9 years (average 4.5 years). There was a highly significant difference (p < 0.0001) in the recurrence rate of patients under, and above, 30 years of age. Twenty per cent of the patients had a concurrent minor fracture at the shoulder with 2 out of 39 of the recurrent cases (5%) and 29 of the 115 non-recurrent cases (25%); this is also a significant difference (p < 0.01). Neither the need for general anaesthesia at primary injury nor the occupation of the patient was a relevant factor in the final outcome of the dislocation. Four nerve injuries were encountered (3%), with no severe sequelae at follow-up. The young patient with no concurrent fracture at the time of the primary shoulder dislocation has a high risk of recurrence.
Adolescent↗
Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder.
Using a dynamic biomechanical model of malunion of the shoulder, we have determined the change in deltoid force required for abduction with various combinations of superior and posterior displacement of fractures of the greater tuberosity of the humerus. We tested eight fresh human cadaver shoulders in a dynamic shoulder-testing apparatus during cycles of glenohumeral abduction from 0 degrees to 90 degrees. The greater tuberosities were osteotomised and stabilised to represent malunion with combinations of superior and posterior displacements of 1 cm and less. The peak force was measured for each displacement in each specimen and statistically compared with values of no displacement using a repeated-measures analysis of variance. The abduction force was significantly increased by 16% (p = 0.006) and 27% (p = 0.0001) by superior displacements of 0.5 cm and 1 cm, respectively, while combined superior and posterior displacement of 1 cm gave an increase in force of 29% (p = 0.001). While treatment criteria for acceptable residual displacement of the greater tuberosity are widely used, there is little information on the direct biomechanical effects of displacement on shoulder mechanics. Although the results of conservative treatment are influenced by a number of factors, including associated injuries, rehabilitation and the pre-existing function of the shoulder, our data suggest that small amounts of residual displacement may alter the balance of forces required to elevate the arm at the glenohumeral joint.
Adult↗
[Pathomechanism of comminuted fractures of the femur head associated with shoulder dislocation].
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Adolescent↗
[Severe complications after percutaneous transaxillary refixation of a glenoid rim fracture].
The common treatment for glenoid rim fractures has been open reduction and internal fixation by a deltopectoral approach. Minimally invasive procedures with percutaneous transaxillary manipulation have a high risk for neurovascular damage. In a single case we demonstrate the possible complications associated with percutaneous refixation of a glenoid rim fracture. A 34-year-old patient with an anterior glenoid rim fracture was referred to our shoulder service after percutaneous transaxillary fixation of the fracture of the glenoid. He presented a dislocated fracture with joint infection and damage of the axillary nerve and artery. During revision surgery, joint infection with Staphylococcus aureus, dislocation of the fracture, aneurysm of the axillary artery, and a lesion in continuity of the axillary nerve were diagnosed. The fragment was excised and the capsule reattached to the remaining glenoid rim. The aneurysm was resected with an end-to-end anastomosis. The outcome was a noninfected and stable shoulder with a limited range of motion. In patients with a glenoid rim fracture with more then 21% of the glenoid fossa involved, refixation of the fracture is recommended. Open reduction and internal fixation is the gold standard. In some cases arthroscopic repair is possible. Percutaneous transaxillary manipulation is not recommended.
Adult↗
[Shoulder injuries in Alpine skiing].
Considering the injuries of the shoulder girdle, cases with ski-injuries admitted to the Garmisch-Partenkirchen Hospital in the past ten years were analyzed. Frequency, age structure and distribution were explored and an attempt was made to connect the mechanisms of trauma with the kind of injury, regarding particularly the ski-specific factors. In the course of the past ten years an increasing relative frequency of dislocations of the shoulder was observed. In elder patients the fractures of the proximal humerus are more frequent, whereas fractures of the clavicle are more frequent in children.
Athletic Injuries↗
Injuries to emergency medicine residents on EMS rotations.
OBJECTIVES: To study the incidence and nature of injuries sustained by emergency medicine (EM) residents during EMS rotations, and steps taken at EM residency programs to increase resident safety during field activities. METHODS: An eight-question survey form was mailed to all 114 U.S. EM residency directors, with a second mailing to nonresponders eight weeks after the initial mailing. RESULTS: A total of 105 surveys were returned (92%). Six surveys were from new programs whose residents have not yet rotated on EMS. These were excluded from further analysis, leaving 99 programs. Of these, 91 (92%) reported no injuries. One EM resident died in a helicopter crash in 1985. Seven other injury events were reported: 1) facial lacerations, rib fractures, and a shoulder injury in an ambulance accident; 2) an open finger fracture (crushed by a backboard); 3) contusions and a concussion when an ambulance was struck by a fire engine; 4) a groin pull sustained while entering a helicopter; 5) bilateral metatarsal fractures in a fall; 6) rib fractures, a pneumothorax, and a concussion in an ambulance accident; and 7) "minor injuries" sustained in a crash while responding to a scene in a program-owned response vehicle. Actions taken at residency programs to reduce the risk of injury include the use of ballistic vests (four programs), requiring helmets on flights (five programs), and changing flight experience from mandatory to optional (two programs). Ten programs (10%) reported using ground scene safety lectures, and nine programs (15% of those offering flights) reported various types of flight safety instruction. Sixty-nine programs (70%) reported no formal field safety training or other active steps to increase resident safety on EMS rotations. CONCLUSIONS: Injuries sustained by EM residents during EMS rotations are uncommon but nontrivial, with several serious injuries and one fatality reported. The majority of EM residency programs have no formal safety training programs for EMS rotations.
Accidents, Occupational↗
Surgical approaches to the shoulder.
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Calcinosis↗
Arthroscopic subscapularis tenolysis: a technique for treating refractory glenohumeral stiffness following open reduction and internal fixation of a displaced three-part proximal humerus fracture.
This case illustrates the treatment of a stiff shoulder following open reduction and internal fixation of a three-part fracture of the proximal humerus. Motion could not be improved with physical therapy or with manipulation under general anesthesia. Arthroscopic subscapularis tenolysis provided a dramatic increase in range of motion. The unique pathological findings may render such cases refractory to manipulation because of thick unyielding scar tissue. In such cases, arthroscopic subscapularis tenolysis may provide the only means of improving the final range of motion.
Adult↗
The floating shoulder: clinical and functional results.
BACKGROUND: Displaced ipsilateral fractures of the clavicle and the glenoid neck are a complex injury pattern that is usually the result of high-energy trauma. The treatment of these injuries is controversial, as good results have been reported with both operative and nonoperative treatment. METHODS: Nineteen patients who had sustained a displaced fracture of the glenoid neck with an ipsilateral clavicular fracture or acromioclavicular separation (floating shoulder) were retrospectively evaluated. The treatment was nonoperative in twelve patients and operative in seven. At the time of final follow-up, standard radiographs were made and all patients were examined by a physical therapist and either a fellowship-trained shoulder surgeon or an orthopaedic traumatologist. In addition, each patient responded to three different validated objective functional outcome measures: the Short Form-36, the American Shoulder and Elbow Surgeons Shoulder Scale, and the Disabilities of the Arm, Shoulder and Hand Questionnaire. Isokinetic strength-testing was performed, and strength in internal and external rotation was compared with that of the uninvolved shoulder. The main outcome measures included fracture-healing, functional outcome, patient satisfaction, and muscular strength. RESULTS: With regard to range of motion, only the amount of forward flexion was found to be significantly greater in the operatively treated group (p = 0.03). The operatively treated shoulders were found to be weaker in external rotation at 300 degrees /sec and weaker in internal rotation at 180 degrees /sec. When normalized to hand dominance, however, the numbers were too small to identify any significant difference. There was no significant difference between groups with regard to the three functional outcome measures. CONCLUSIONS: Good results may be seen both with and without operative treatment. Therefore, we cannot universally recommend operative treatment for a double disruption of the superior suspensory shoulder complex. Treatment must be individualized for each patient.
Adolescent↗
Axillary artery injury from humeral neck fracture: a rare but disabling traumatic event.
Axillary artery injury from blunt trauma to the shoulder is uncommon. Fracture of the neck of the humerus is a rare cause of injury to the axillary artery. Four cases of axillary artery thrombosis from humeral neck fracture are reported. Each of the first 2 patients presented with a pulseless and acutely ischemic limb after a trivial fall. A repair of the axillary artery with saphenous vein interposition graft was performed in the first patient. The extremity was salvaged, but a residual radial and ulnar neurologic deficit persisted. The second patient presented with a pulseless insensate upper extremity accompanied by motor loss. He underwent primary axillary artery repair. Still early in his postoperative course, he has had global brachial plexopathy and is undergoing intensive physical therapy. The third patient had a delayed presentation of brachial plexopathy and sympathetic reflex dystrophy. Arterial reconstruction was not required owing to excellent collateralization. The fourth patient presented with a cool pulseless extremity. His recovery is nearly complete after bypass of the axillary artery with a reversed saphenous vein graft. In addition, a review of the literature revealed 24 cases of axillary artery injury associated with humeral neck fracture. The mean age was 66.6 years. The most common mechanism of injury was a fall (79%). Thirteen patients (46%) presented with a neurologic deficit. Acute ischemia was present in 68%. Physical examination predicted the arterial injury in all but 1 patient. The injured axillary artery was repaired in 26 cases. Revascularization by an interposition graft was the most common procedure. All grafts and reanastomoses were patent and led to limb salvage. Of 9 primary repairs, 3 amputations were performed. Although limb salvage rate was 89%, a good functional outcome was obtained in only half of the patients. A high index of suspicion is required for early diagnosis of axillary artery injury. Despite excellent results of vascular reconstruction, the outcome remains determined by the excessive neurologic morbidity. Recognition of the associated brachial plexus injury is essential to improve the functional outcome of this unusual arterial injury.
Accidental Falls↗
Long-term risk of osteoporotic fracture in Malmö.
The objectives of the present study were to estimate long-term risks of osteoporotic fractures. The incidence of hip, distal forearm, proximal humerus and vertebral fracture were obtained from patient records in Malmö, Sweden. Vertebral fractures were confined to those coming to clinical attention, either as an inpatient or an outpatient case. Patient records were examined to exclude individuals with prior fractures at the same site. Future mortality rates were computed for each year of age from Poisson models using the Swedish Patient Register and the Statistical Year Book. The incidence and lifetime risk of any fracture were determined from the proportion of individuals fracture-free from the age of 45 years. Lifetime risk of shoulder, forearm, hip and spine fracture were 13.3%, 21.5%, 23.3% and 15.4% respectively in women at the age of 45 years. Corresponding values for men at the age of 45 years were 4.4%, 5.2%, 11.2% and 8.6%. The risk of any of these fractures was 47.3% and 23.8% in women and men respectively. Remaining lifetime risk was stable with age for hip fracture, but decreased by 20-30% by the age of 70 years in the case of other fractures. Ten and 15 year risks for all types of fractures increased with age until the age of 80 years, when they approached lifetime risks because of the competing probabilities of fracture and death. We conclude that fractures of the hip and spine carry higher risks than fractures at other sites, and that lifetime risks of fracture of the hip in particular have been underestimated.
Age Factors↗
Shoulder pain: a diagnostic dilemma.
The etiology of shoulder pain can usually be placed into one of five categories: fracture and/or contusion, shoulder separation involving the clavicle, instability of the glenohumeral joint, impingement syndrome involving the rotator cuff or biceps tendinitis, and frozen shoulder. Non-shoulder pathology, such as cervical strain, thoracic outlet syndrome and referred pain from phrenic nerve irritation, should be excluded when evaluating patients presenting with shoulder pain. After inflammatory or infectious arthritis has been ruled out, the history should point to either acute trauma or an overuse injury. Physical examination may provide information about neurovascular status, palpable tenderness, range of motion, strength, instability and impingement. Radiographic studies are usually indicated in patients with a history of trauma, but they are often not necessary in the initial evaluation of overuse injuries. Magnetic resonance imaging and arthrograms should be reserved for patients who have not responded to six to eight weeks of conservative treatment and are candidates for surgery.
Acromioclavicular Joint↗
Stress fracture of the proximal humeral epiphysis in an elite junior badminton player.
An elite junior badminton player presented with a chronic painful dominant shoulder after an intense training course. An acute stress fracture to the proximal humeral epiphysis was found. Two-plane radiography will identify abnormalities of the growth plate but comparative films of the unaffected side may also be required to differentiate subtle changes. Rest with subsequent rehabilitation is the appropriate management of these injuries although ideally they should be subjected to primary prevention.
Adolescent↗
Fractures of the scapula surgical neck: outcome after conservative treatment in 13 cases.
BACKGROUND: Conservative treatment of fractures of the scapular neck does not uniformly lead to a success. The purpose of this retrospective study was to analyze the occurrence of glenoid displacement in conservatively treated patients with a scapular neck fracture without concomitant shoulder girdle injury in relation with the clinical outcome. METHODS: Between 1991 and 2001, 177 patients with a fracture of the scapula were treated in two Dutch clinics. Twenty-four patients sustained a scapular neck fracture, who all, with the exception of one, were treated non-operatively. At follow-up, 13 patients had a functional evaluation and were assessed clinically at an average of 5.5 years after the injury. RESULTS: All fractures healed uneventfully. At final radiographic evaluation, four patients were found with significant translational displacement of fracture fragments (>1 cm); however, no angular displacement of the glenoid was found (no GPA < 20 degrees ). The functional outcome of the 13 patients was excellent (Constant score: 90). No correlation was found between functional outcome and malunion. There was no significant difference between the SF-36 scores in the follow-up group and the scores for age-matched controls in the general population. CONCLUSIONS: Non-operative treatment of a surgical neck fracture of the scapula in absence of an ipsilateral shoulder injury and associated permanent neurological impairment leads to a good to excellent functional outcome, with or without significant translational displacement.
Adolescent↗
Treatment of scapula fractures: systematic review of 520 fractures in 22 case series.
BACKGROUND: Fractures of the scapula account for 3% to 5% of all fractures of the shoulder girdle and make up less than 1% of all broken bones. Scapula fractures typically occur after high-energy trauma, and approximately 90% of the patients have associated injuries. OBJECTIVE: (1) To determine the incidences of nonoperative and operative treatment of different scapula fracture types, (2) to systematically stratify the reported results of nonoperatively and operatively treated scapula fractures on the basis of different fracture types and to summarize functional results, and (3) to quantify infection and secondary surgical procedure rates after operative treatment.
Adult↗
[Diagnosis of ulnar fractures combined with radial dislocations in the shoulder].
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Adolescent↗