Shoulder and Elbow Fractures

Elbow fractures are often caused by:

• Falling onto your elbow
• Receiving a direct blow to the elbow
• Falling onto an outstretched arm

The symptoms of elbow fractures include:

• Pain, swelling, bruising in and around the elbow
• Visible deformity of the elbow
• Weakness or numbness in the arm, wrist and hand
• A snapping or popping sound at the time of injury

Elbow fractures are diagnosed using:

• A physical examination to check for cuts and tenderness
• Assessment of your fingers and wrist to see if there are any other injuries to nerves surrounding the shoulder and elbow
• An X-ray shows whether the bones are fractured and how severely
• You may require a CT scan if the injury is severe

Treatment will vary depending on the type and severity of the fracture. Unstable fractures or those where the bones have become displaced are more likely to require surgery to realign and stabilise the fracture whilst the bone heals or replace the fragments if they are to displaced or injured to repair.

Open fractures, where the skin is broken over the fracture, will need urgent surgery to clean out the wound and bone to minimise the risk of infection.

If there is a low risk of the bones moving out of place or when bones remain in the correct position, treatment may involve wearing a sling, cast or splint while the fracture heals. Children are more likely to be offered non-surgical treatment (cast or sling) as there is very little risk of elbow stiffness.

Among the surgical procedures that may be offered are:

• Open reduction and internal fixation – The bone fragments are repositioned into their normal alignment before being fixed in place with plates, screws or wires.
• Bone graft – If some of the bones have been lost or crushed you may need a bone graft from a donor or from another bone in your body, generally the pelvis.
• Removal of bone fragments – If fragments are too small to repair they may be removed. The bone fragments that have been removed may sometimes be exchanged with metal replacements and the ligaments or tendons that attach to the removed fragments are repaired.

Rehabilitation is important to improve mobility and prevent stiffness. This might include exercises recommended by a physiotherapist, ultrasound, scar massage or splints that stretch the joint.

Fractures of the shoulder (clavicle or proximal humerus) are often caused by:

• Falling heavily onto your shoulder
• A direct blow to the shoulder as the result of a road traffic accident, fall or collision

Fractures of the scapula are less common and are normally the result of a high impact trauma such as a high-speed motor vehicle accident. They are often associated with chest injuries.

The symptoms of shoulder fractures include:

• Pain, swelling and bruising
• Inability to move the shoulder
• Deformity of the shoulder
• A grinding sensation when the shoulder is moved
• Pain or numbness in the hand from injury to the nerves surrounding the shoulder

Clavicle fractures may produce:

• Swelling and bruising over the collarbone
• A bump under the skin
• Pain when moving the shoulder

Proximal humerus fractures may produce:

• Severe swelling in the shoulder accompanied by severe pain
• Very limited movement in the shoulder

Scapular fractures may produce:

• Severe bruising around the shoulder blade
• Pain which limits your shoulder movement

Shoulder fractures are diagnosed using:

• A physical examination to check for cuts and tenderness
• Assessment of your fingers and wrist to see if there are any other injuries to nerves surrounding the shoulder and elbow
• An X-ray shows whether the bones are fractured and how severely
• You may require a CT scan if the injury is severe

Treatment depends on where the fracture is located and how badly fractured the shoulder is.

• Clavicle fractures: Treatment can be non-surgical, which involves wearing a sling to immobilise your arm while the bones heal. This can take three to six weeks in children and six to twelve weeks in adults. An open fracture where the bones has broken through the skin or is severely out of place may require surgery to fix it in place using plates and screws
• Proximal humerus fractures: Decisions regarding surgery for proximal humerus fractures are generally tailored to each patient and fracture pattern. Simple undisplaced fractures can be treated without surgery, generally in a collar and cuff. If there is a nerve injury or the bone fragments are shifted significantly out of position they will be fixed in place with plates, screws or pins. In some cases, a shoulder replacement is needed.
• Scapula fractures: The bones need to be immobilised using a sling or shoulder immobiliser to allow them time to heal. Around 10-20% of scapula fractures need surgery to fix the fragments in place with plates and screws depending on where the scapula has been fractured.