Shoulder fractures: how to treat them effectively
The best treatment options for shoulder fractures.
Gabriele February
5 min. Jan 18, 2025
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TL:DR:
● Shoulder fractures can be treated conservatively or surgically.
● The choice of treatment depends on the severity of the fracture and the patient's condition.
● Reverse shoulder replacement is an effective solution for complex fractures.
An innovative approach to the treatment of shoulder fractures
Shoulder fractures are one of the most common injuries in orthopedics, especially among the elderly. These fractures can result from direct trauma, falls, or sports injuries and can range in severity, from simple fractures to complex fractures involving multiple bone fragments. Management of these fractures is crucial to ensure optimal functional recovery and reduce the risk of long-term complications.
Types of shoulder fractures
Shoulder fractures can be classified based on their location and severity.
● Fractures of the humeral neck, humeral head, and scapular fractures are among the most common. Complex fractures, such as three- or four-part fractures, require special attention and often surgery to ensure proper healing.
Clavicle fractures are common injuries that typically occur as a result of direct trauma or falls. The clavicle, or key bone, is located in the upper chest and connects the arm to the sternum. These fractures can vary in severity: a simple fracture may present with pain and swelling, while a compound fracture, in which the bone breaks into multiple pieces, may require surgery. Examples of situations that can cause clavicle fractures include sports accidents, such as a fall during a soccer game or a bicycle accident. Prompt diagnosis and appropriate treatment are essential to ensure a successful recovery. There are very specific criteria for surgical intervention or non-surgical treatment with a brace for this type of fracture, and these must be analyzed on a case-by-case basis.
● Glenoid fractures are injuries affecting the glenoid cavity, a key part of the shoulder joint. These fractures can compromise shoulder stability, leading to an increased risk of dislocation. For example, a fracture of the inferior glenoid can affect anterior stability. Early diagnosis and appropriate treatment (now also possible through arthroscopy with three small incisions) are essential to restore function and prevent long-term complications.
Treatment options
The treatment of shoulder fractures can be divided into two main categories: conservative and surgical.
1. Conservative treatment: It is a fundamental strategy in the management of non-displaced or stable fractures, aimed at promoting healing without surgery. This approach may involve the use of braces to stabilize the affected area, physical therapy to improve mobility, and analgesic medications to relieve pain. For example, a non-displaced humeral head fracture can be treated with a brace and physical therapy sessions to restore shoulder function. Similarly, in the case of a clavicle fracture, rest and immobilization can promote normal recovery, avoiding complications associated with invasive surgery.
2. Surgical treatment: More severe fractures or those that do not heal properly with conservative treatment may require surgery. Surgical options include:
a. Osteosynthesis: Use of plates and screws to stabilize bone fragments. Osteosynthesis is a fundamental surgical technique used to stabilize bone fragments after a fracture. This process involves the use of plates and screws that, fixed directly to the bone, allow for proper alignment and healing of the fragments. Osteosynthesis is a crucial surgical technique for the treatment of shoulder fractures. An example is a proximal humerus fracture, where plates and screws or intramedullary nails are used to stabilize the bone fragments and promote proper healing. This approach restores joint mobility and reduces the risk of complications. Another example is a humeral trochanteric fracture, where the use of screws inserted through very small incisions or arthroscopically placed anchors may be necessary to maintain alignment and ensure effective healing and rehabilitation, allowing the patient to return to normal daily activities.
b. Reverse shoulder replacement: This procedure is particularly indicated for complex humeral head fractures, especially in elderly patients with osteoporosis. The reverse prosthesis allows for improved mobility and reduces pain, significantly improving the patient's quality of life.
Scientific evidence
A study published in the journal EFORT Open Reviews found that improved implant characteristics, combined with surgeon experience, led to a significant reduction in complications associated with reverse shoulder arthroplasty. However, some complications, such as acromial stress fractures, remain a challenge (Nabergoj et al., 2021, pp. 1097–1108).
Another systematic review found that reverse shoulder arthroplasty offers better functional outcomes than nonsurgical treatment for complex proximal humeral fractures in older adults (Bosch et al., 2024). This suggests that, despite the higher initial costs, reverse arthroplasty may be a more effective long-term treatment strategy.
Conclusions
The management of shoulder fractures requires a personalized approach, taking into account the patient's specific conditions and the severity of the fracture. Reverse shoulder arthroplasty is emerging as one of the most promising options for treating complex fractures, offering superior functional outcomes and improved quality of life for elderly patients. It is essential that orthopedic surgeons stay up-to-date on the latest scientific evidence and surgical techniques to ensure the best possible treatment.
Bibliography
1. Nabergoj, M., Denard, P., Collin, P., Trebše, R., & Lädermann, A. (2021). Mechanical complications and fractures after reverse shoulder arthroplasty related to different design types and their rates: part I. EFORT Open Reviews, 6, 1097-1108. DOI: 10.1302/2058-5241.6.210039 (Nabergoj et al., 2021, pp. 1097–1108).
2. Bosch, T. P., et al. (2024). Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review. Journal of Clinical Medicine, 13. DOI: 10.3390/jcm13010001(Bosch et al., 2024).