Types of Shoulder Fractures

The shoulder joint is formed where three bones come together: the arm bone (the humerus), the collarbone (the clavicle), and the shoulder blade (the scapula at the glenoid).  When someone sustains a shoulder fracture, any one of these bones may be injured.  Determining the best treatment depends on the specific injury.  Here you can learn about different types of shoulder fractures, and what can be done for treatment of these injuries.

Proximal Humerus Fractures

shoulder fracture
Bones of the shoulder joint. Image © Medical Multimedia Group

Most people who talk about a shoulder fracture are describing a fracture of the proximal humerus.  A proximal humerus fracture is an injury to the top of the arm bone (the humerus), which forms the ball of the ball-and-socket shoulder joint.  Proximal humerus fractures can occur in younger patients as a result of traumatic injury, and also occur in the elderly population as a result of osteoporosis.

Proximal humerus fractures come in many types, and treatment can range from a simple sling, to a shoulder replacement surgery.  Therefore, it is important to discuss with your orthopedic surgeon your specific expectations about your shoulder function so that you can find the best treatment option.

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Clavicle Fractures

Clavicle fractures are the most common type of shoulder fracture, and may also occur in a broad range of ages from newborn to elderly.  The vast majority of clavicle fractures are treated with simple rest and the use of a sling, but there are some fractures that may need more aggressive surgical treatment.

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Glenoid Fractures

Fractures of the glenoid are relatively uncommon.  The glenoid forms the socket of the shoulder joint, and is part of the shoulder blade (scapula).  Fractures of the glenoid may be associated with a shoulder dislocation, and often lead to persistent shoulder instability if left untreated.

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Scapular Fractures

The scapula is the name of the shoulder blade.  The shoulder blade is a wide, thin bone, that also forms the socket of the ball-and-socket shoulder joint (called the glenoid). 

The shoulder blade is very important for normal shoulder movement, as about 1/3 of normal shoulder motion comes from the scapula moving on the rib cage, the other 2/3 is the ball-and-socket. 

Scapular fractures are most often associated with significant trauma.  Because of the location of the shoulder blade, people who sustain a scapular fracture should also be evaluated for associated chest injuries.

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Fracture-Dislocations

A fracture-dislocation occurs when there is both a broken bone and a dislocation of the joint.  The most common type of fracture-dislocations occur with shoulder dislocations with an associated injury to the ball of the ball-and-socket called a Hill-Sachs injury.

Other types of fractures can occur with shoulder dislocations including displaced proximal humerus fractures and glenoid rim fractures.  The common theme with all of these injuries is that shoulder instability may occur if the fracture heals in a poor position.

Treatment of Shoulder Fractures

Anyone suspected of injuring the bones around the shoulder joint should be evaluated by a physician.  Signs of shoulder fractures may include:

  • Bruising around the shoulder (may travel down the arm over time)
  • Swelling of the shoulder and arm
  • Pain with simple shoulder movements
  • Deformity of the joint

If you have these symptoms, an x-ray will likely be obtained to determine the type and severity of the injury.  If the extent of the injury is not clear, additional tests may help to evaluate the condition.

Treatment of shoulder fractures is quite variable ranging from simple immobilization to complex surgical procedures.  You should discuss treatment options with your surgeon who can advise you on the pros and cons of different methods of treatment.

Sources:

Nho SJ, et al. "Innovations in the Management of Displaced Proximal Humerus Fractures" J Am Acad Orthop Surg January 2007 vol. 15 no. 1 12-26

Jeray KJ. "Acute Midshaft Clavicular Fracture" J Am Acad Orthop Surg April 2007 vol. 15 no. 4 239-248

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