Shoulder fractures & dislocations

 Outstrech hand

 AP  30 degree cephalad view

 Injury to brachial plexus, great vessels, lungs  Malunion  Nonunion

 Anterior (95-97%)  Subcoracoid (most common)  subglenoid (1/3 associated with # greater tuberosity, or # glenoid rim)  subclavicular  Posterior  Inferior and superior

 Arm in abduction and external rotation. Force is taken on the hand or arm which increases the external rotation of the arm causing the head of the humerus to dislocate

 2-4% of shoulder dislocations  Secondary to seizure, direct blow to shoulder  Need to dx early to prevent long term complications

Adduction,int.rotation

 AP may appear normal!  “light bulb” – int rotation of humeral head

 1)Counter traction traction  2)stimson

 Mechanisms of Injury:  Fall on the tip of the unprotected shoulder.  Fall on the outstretched hand. 1)partial 2)complete

 Grade I  Mild tenderness over AC joint, mild swelling  Full ROM  Grade II  Mod/severe pain, clavicle slightly displaced up  Grade III  Arm kept in adduction, obvious deformity

 Diagnose X-ray

 Complete open reduction I and II Conservative (sling, ice, analgesia, physio) 6/52 before lifting III Conservative with late distal clavicle excision Refer to Ortho <72h

 Rare  Most treated conservatively  Intraarticular displacement may need ORIF

 Conservative  OR

 Common anterior  Bankart leision  Hill-sachs leision  Apprehension test

 Diagnose)CT SCAN Lat.Rotation abduction