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So what exactly holds your shoulder on?

2/6/2015

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Picture
So while evading a piece of runaway machinery, this gent fell over a wall and landed heavily on his left shoulder.  Shoulder and scapula views were ordered.  What's he done?  Just as importantly, when does this need more than than just time in a sling and physio....?
There's a fracture through the glenoid neck.  So, a brief revioe wof the management of scapula fractures from our very own Mark Brinsden:

1.  Extra-articular (glenoid) scapular fractures:  Is the glenohumeral joint connected to the axial skeleton?  The answer lies in the integrity of the Superior Suspensory Complex (SSC):

If the circle is intact (and the clavicle is not fractured) the GHJ is still connected to the axial skeleton via the coracoid - CC ligaments - Clavicle - Sternum - Ribs - Spine.  If there is a fracture between the glenoid (neck) and the coracoid (v. rare) we would have to plate the glenoid back onto the scapular body to restore the integrity of the SSC.

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2.  Intra-articular scapular fractures (glenoid).  Traditionally, any displaced (>2mm) intra-articular fracture would undergo ORIF.  There is increasing evidence that this is not required.  The modern-thinking is that even displaced intra-articular fractures maybe managed non-operatively as long as there is no subluxation of the humeral head anteriorly or posteriorly i.e. the displaced fragment is not behaving like a large bony Bankart lesion.

Finally, in the absence of a surgical indication the mainstay of management is analgesia and PHYSIO +++.  A scapular fracture is a massive trauma to the shoulder girdle and the soft tissue stiffness that can occur "downstream" is immense, so move please ++++++++! 


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  • Home
    • About us >
      • Accommodation in Plymouth
      • Contact us
    • TUEC >
      • Timeline
      • Current drawings
    • ED_Design
  • Academic
    • Who are we?
    • Live Studies
    • Why academic EM?
    • In the literature
    • Derribets
  • Education
    • Simulation
    • Derrifoam Blog >
      • Get involved
      • FOAM
    • Education Faculty >
      • Core Education guide
    • Induction >
      • MG doctor induction >
        • CT3 in Emergency Medicine
        • Clinical Fellow in EM & Medical Education
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    • Core education >
      • non-accs
      • accs
    • Higher specialist education
    • Nursing education
    • Practitioner education
  • Clinical
    • EM Induction
    • Guidelines