Fractures Around the Shoulder: Radiologic Update on Surgical Fixation Techniques

Abstract

Although radiologists are likely familiar with basic fracture patterns around the shoulder, certain fracture types in this area have particularly relevant and controversial clinical management issues. These include proximal humeral fractures, in which conservative management is favored but some patients receive surgical treatment; glenoid fractures and Hill-Sachs lesions, in which surgery may be performed depending on the amount of bone loss; and distal clavicular fractures, in which certain displaced fractures have high rates of nonunion, but there is no clearly favored surgical technique. Knowledge of the different clinical issues and surgical options can aid the radiologist in identifying key imaging findings and creating a useful report.

Coracoclavicular Double-Button Fixation of Displaced Lateral Clavicular Fracture in a Patient without Coracoid Process

“…Displaced distal clavicular fractures are generally operated on because of the high nonunion rate after nonoperative treatment [3,9].…”

Imaging Considerations in Musculoskeletal Trauma

“…Proximal humerus fractures are commonly the result of low-energy falls in elderly patients with osteopenic bone and high-energy traumas, such as MVCs or falls from heights in younger patients. 36,41 Initial imaging should consist of a shoulder trauma series of plain radiographs; this includes a true AP (or Grashey) view, scapular Y, and axillary views. 36,41 The axillary view is especially helpful for evaluating greater and lesser tuberosity fractures, humeral head-splitting fractures, and glenohumeral dislocations.…”

“…36,41 Initial imaging should consist of a shoulder trauma series of plain radiographs; this includes a true AP (or Grashey) view, scapular Y, and axillary views. 36,41 The axillary view is especially helpful for evaluating greater and lesser tuberosity fractures, humeral head-splitting fractures, and glenohumeral dislocations. 41 A CT scan is indicated for further evaluation of intra-articular fractures and for surgical planning.…”

“…36,41 The axillary view is especially helpful for evaluating greater and lesser tuberosity fractures, humeral head-splitting fractures, and glenohumeral dislocations. 41 A CT scan is indicated for further evaluation of intra-articular fractures and for surgical planning. 36,41 CT scans are also helpful for determining the position of the humeral head and greater tuberosity when their positions are unclear on plain films and for diagnosing occult proximal humerus fractures.…”

“…41 A CT scan is indicated for further evaluation of intra-articular fractures and for surgical planning. 36,41 CT scans are also helpful for determining the position of the humeral head and greater tuberosity when their positions are unclear on plain films and for diagnosing occult proximal humerus fractures. 36,41 MRI may also be helpful for diagnosing occult fractures but is generally not used for surgical planning, unless the injury is in fact to the rotator cuff rather than to the bone itself.…”