FRACTURES
Proximal humerus fracture Proximal humerus fractures (PHF) are common—they are the seventh most frequent fracture in adults, with a prevalence rate from 4% to 10% of all fractures (Iglesias-Rodriguez et al., 2021). In older adults, they are the third most common fracture type (behind distal radius and vertebrae (Schumaier & Grawe, 2018). These fractures can be recognized as high energy (e.g., due to a motor vehicle crash in young patients) or low energy (e.g., due to an elderly patient falling on ground level). They are most common in patients over age 65 years, especially those with osteoporosis or osteopenia. During subjective interviews, clinicians should consider asking about activity levels, occupational performance, and bone density scans to determine the possibility of a PHF (Pencle & Varacallo, 2023). The Neer classification for proximal humerus fractures is based on four fracture locations: The greater tuberosity, the lesser tuberosity, the humeral head, and the humeral shaft (Schumaier & Grawe, 2018). Classification is also based on the number of displaced segments. A segment is considered to be displaced if there is greater than 1-cm separation or 45-degree angulation (Carofino & Leopold, 2013). A classic article by Carofino & Leopold (2013) describes the Neer classification categories as follows: ● One-part fractures : For a one-part fracture, none of the fracture fragments are displaced. This term applies regardless of the actual number of fracture lines or their location. ● Two-part fractures : In two-part fractures, one segment is displaced. The displaced part may be the greater Hill-Sachs impaction fracture This injury occurs almost exclusively as a consequence of anterior shoulder dislocation (Wong et al., 2015). During anterior shoulder dislocation, the posterior aspect of the humeral head can collide with the glenoid, resulting in a compression fracture of the posterolateral humeral head and an impaction deformity (Alkaduhimi et al., 2022). Bankart fracture Bankart fractures are often associated with Hill-Sachs lesions due to a shared mechanism of injury (Wong et al., 2015). The soft tissue Bankart lesion is an injury to the anterior or anteroinferior glenoid labrum, while an osseous Bankart fracture is a chip fracture of the anterior inferior glenoid rim (Wong et al., 2015). A history of shoulder trauma with dislocation is typical. Individuals who regularly participate in contact sports such as football, soccer, or basketball should Clavicle fracture Fractures of the clavicle occur primarily in young males (Kihlström et al., 2017). The most common mechanism of injury is falling directly on the shoulder, often from a bicycle or motorcycle (Kihlström et al., 2017). The majority of fractures occur in the mid-shaft of the clavicle (69% to 82%), followed by 12% to 26% in the lateral aspect and 2% to 6% in the medial aspect. The middle part of the clavicle is more vulnerable, as it does not have the strong ligament and muscle attachments that the medial and lateral parts of the clavicle have (Kihlström et al., 2017). Common signs Scapular fracture Scapular fractures are often the result of high-energy trauma where the scapula is impacted by a direct force (Pinto et al., 2018). Sußiek et al. (2021) analyzed the epidemiological
tuberosity, lesser tuberosity, or articular segment at the level of the anatomic neck or surgical neck. ● Three-part fractures : For three-part fractures, both one tuberosity and the surgical neck are displaced. The remaining tuberosity is attached, and a rotation deformity is created. ● Four-part fractures : In four-part fractures, four segments (both tuberosities, the articular surface, and the shaft) are displaced and the articular surface is often laterally displaced (and consequently out of contact with the glenoid). This is a serious injury that creates a high risk of avascular necrosis. Signs and symptoms of proximal humerus fracture include: ● Ecchymosis that may extend to the chest, arm, and forearm. ● Crepitus and pain over the fracture site. ● Loss of shoulder contour or presence of shoulder deformity. ● Limited shoulder range of motion/function. Healthcare Consideration: Approximately 85% to 90% of proximal humerus fractures are considered appropriate for nonoperative treatment (Kruithof et al., 2017). These include fractures that are minimally displaced with little angulation. Conservative treatment typically consists of one to two weeks of wearing a sling followed by therapy. According to Kruithof et al. (2017), almost two-thirds of patients have good long-term functional outcomes with conservative treatment of a proximal humerus fracture, and only 10% suffer considerable loss of daily function. Acutely, the presentation includes shoulder pain, weakness, and limited range of motion (Herring & Davis, 2021). Long-term, this injury can result in shoulder instability, and patients may demonstrate a positive shoulder apprehension test (Yoo et al., 2018). be considered. Patients may report pain with occupational- or sports-related performance activities that require overhead motion; a feeling of instability and weakness; limited shoulder range of motion; and catching, locking, popping, or grinding (Athwal, 2022b). According to Loh et al. (2016), patients with recurrent shoulder dislocations and positive findings with the anterior apprehension and load and shift tests are very likely to have a Bankart lesion. and symptoms are inability to lift the arm because of pain; sagging of the shoulder downward and forward; a grinding sensation when lifting the arm; a deformity or bump over the break; and bruising, swelling, or tenderness over the collarbone (Githens & Lowe, 2022) Fractures of the lateral one-third of the clavicle have a relatively higher incidence of nonunion (approximately 30% to 45%). This type of fracture is secondarily seen in individuals over the age of 70 who fall on their shoulder (Kim et al., 2020).
data around scapular fractures and found the average age of patients with this diagnosis to be 62 and the leading cause to be a traumatic fall from standing height. Scapular
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