Shoulder and elbow fractures

Shoulder/Elbow Fractures

Anatomy

The shoulder is a ball-and-socket joint with the greatest range of motion of all the body’s joints. It consists of three bones:

the clavicle, or collarbone
the scapula, or shoulder blade
the proximal humerus, which is the rounded uppermost part of the arm bone
These bones intersect to form two joints in the shoulder

3-D CT Reconstruction of Shoulder area showing Clavicle, Scapula , Proximal Humerus and the Acromio Clavicular (A C/ Collar bone joint) & the Glenohumeral (Ball & Socket) joint.

Injury

A fracture can occur in any of the bones in the joint
Muscles, tendons, and ligaments surround and stabilize the joint and help prevent the bones from moving out of place
These may also be injured when a fracture occurs

Symptoms

Symptoms vary depending on the specific type of fracture but may include:

Pain
Swelling and bruising
Inability to move the shoulder

A grinding sensation when the shoulder is moved
Deformity — “It does not look right.”

Occasionally bleeding (open fracture)
Loss of normal use of the arm if a nerve injury occurs

A fracture may be classified as

Closed

the broken bone remains beneath the skin

Open

a fragment of bone breaks through the skin

Displaced

bones are separated into two or more pieces that don’t remain in contact with each other

Non displaced

when the pieces of the broken bone don’t separate and the bone fragments remain in place

Different fractures that can happen

Clavicle Fracture

The clavicle, also called the collarbone, is a long bone that connects the shoulder blade to the breastplate, or sternum
A broken collarbone is the most common type of shoulder fracture
Symptoms include a sharp pain at the site of injury, swelling, and bruising
The patient may find it difficult to move the arm and the movement may cause a painful grinding sensation where the ends of the broken bone rub against each other
A broken collarbone may also cause the shoulder to sag downward, and a bump may be visible beneath the skin where the bone has fractured
If the fracture is caused by a high-impact injury such as a car accident, the bone may stick through the skin, which is referred to as an open fracture

Radiographs showing Clavicle fracture and Plating

Scapula Fracture

The scapula, or shoulder blade, is a large, flat, triangular bone on the back that connects the humerus, or upper arm bone, and the clavicle, or collarbone
The shoulder blade is well protected by surrounding muscles and doesn’t break easily, but a high-energy, direct impact—as might result from a car or motorcycle accident—can cause the bone to fracture into two or more pieces
Symptoms include significant, sharp shoulder pain when the injured attempts to move the arm, as well as swelling, bruising, and tenderness in the skin over the injury
Shoulder blade fractures are rarely open fractures, and they may not require surgery to heal

Radiographs showing fixation of Scapula and Clavicle Fractures

Proximal Humerus Fracture

The proximal humerus is the rounded upper part of the arm bone that rotates within the shoulder socket
This bone may fracture because of an impact from a fall or car accident, or as a result of a shoulder dislocation, in which the humerus is forced out of the joint socket
Symptoms include severe pain, limited motion in the shoulder, swelling, tenderness, and a cracking or popping sound, called crepitus, when the patient attempts to move the arm
This type of shoulder fracture is more common in people with osteoporosis, a condition that causes bones to become weak and brittle and increases the risk of any type of fracture

Radiographs Showing Proximal Humerus Fracture and Plating

Elbow Fractures

Anatomy

The elbow is a hinge joint that allows the movement of the forearm—which extends between the elbow and the wrist—back and forth, as well as rotate the palm to face up or down
The elbow connects the upper arm, or humerus, to the radius and ulna, the bones that make up the forearm
A fracture may occur in one or more of the bones that form the elbow
An injury to the elbow may also pull the bones of the joint out of place, compromising the stability and range of motion of the joint called a fracture dislocation

Different fractures that can happen

Olecranon Fracture

The olecranon is an extension of the ulna, one of the two bones in the forearm
When the arm is bent, it forms the point at the tip of the elbow
The olecranon is not covered by any muscles or ligaments, so it’s especially vulnerable to fracture if the elbow makes direct contact with a hard surface
Most commonly it happens as a result of a strong, sudden contraction of the triceps muscle, located above the elbow, during a fall
The muscle contraction, called an eccentric contraction, is sometimes so strong that the force overwhelms the olecranon, resulting in a break in the bone
Symptoms include sharp pain, an inability to extend the elbow, swelling, and tenderness
The broken bone may also cause a visible protrusion beneath the skin

CT scan showing elbow ( complex Olecranon) fracture and Fixation

Radial Head Fracture

The radial head is the part of the radius bone in the forearm that meets the humerus within the elbow joint
A radial head fracture may occur if you put your hand out to break a fall
The force of impact may travel through the radius and push the radial head into the bottom of the humerus with such force that it fractures
Dislocating the elbow, a type of injury in which the bones of the joint become separated, can put stress on the radial head and lead to a fracture
Symptoms include pain when the elbow is extended, swelling, and difficulty in rotating the forearm
For example, turning the palm up or down may be painful

Radiographs showing Radial Head Replacement following complex Radial Head Fracture

Distal Humerus Fracture

The distal humerus is the rounded bottom part of the bone that connects the elbow to the shoulder
In the elbow, it rotates against the radial head and ulna, forming the upper part of the joint
Fractures of the distal humerus are relatively uncommon, but may occur as the result of a hard blow to the elbow, falling directly onto a bent elbow, or putting out your hand to break a fall while the elbow is extended straight
Symptoms include intense pain, tenderness, and swelling in and above the elbow
You may not be able to extend the elbow, or the joint may feel weak or unstable, especially if you attempt to pick up an object or put weight on the affected arm

Radiographs showing Distal Humerus Fracture treated with fixation

Diagnosis

Shoulder and elbow fractures require immediate care in order to heal and prevent permanent damage to the bone or surrounding soft tissues. In case of an injury it is recommended to get medical attention immediately.