33. Fracture of the shoulder girdle

Essay 33- Fracture of the shoulder girdle

What constitutes the shoulder girdle?
The shoulder girdle is composed of the clavicle and the scapula, which articulates with the proximal humerus of the upper limb.

What are the types of scapular fractures?
Fracture of the scapular body
Fracture of the scapular cervix
Fracture of the processes (acromion, scapular spine, coronoid process)
Fracture of the scapular body
Mechanism- high energy direct trauma, gunshot wounds
The fracture line can pass transversely along the length so that the inferior angle or medial angle is detatched
Symptoms- pain localised in region of scapula (becomes worse when shoulder girdle moves
Possible pulmonary damage
Commoli sign- triangular swelling over scapula secondary to fracture hematoma.
Examination shows edema (hematoma) and pain is induced on palpation
X-rays show the fracture line
Fracture of the scapular cervix (neck)
Mechanism- indirect compression, flexion mechanism (falling on shoulder or hitting it)
Glenoid cavity is also fractured due to compression
Symptoms- pain, deformity in region, whole humeral joint is dislocated downwards, protrusion of acromion
Edema, pain on palpation, hemorrhages, painful movements
Whole upper extremity gets detached from scapula- shoulder has a sharp shape

Fractures of the processi
Mechanism:
Direct blow causes acromion fractures
Fracture of coronoid process results from direct trauma
Scapular spine is fractured in direct trauma
Symptoms- pain, edema, bone crepitations (acromion)
First aid- upper extremity is immobilised with Mitella (triangular towel)
Treatment
Scapular body- arm placed in Mitella for 3 weeks (encourage mobilisation after 3-4 days)
Cervical fractures- reduction and immobilisation for 5 weeks!
Fractures of processi- immobilisation and osteosynthesis