Shoulder Fractures

Has this article been insightful? Share it!

What is a Shoulder Fracture?

A shoulder fracture refers to a broken bone within the shoulder joint. Depending on which types of bones are broken, shoulder fractures can be classified into the following types:

Proximal humerus fracture
Glenoid fracture
Scapula fracture

Additionally, shoulder fractures can also be further classified in the following ways:

Displaced vs. non-displaced shoulder fractures
Displaced fractures involve bone fragments shifting out of position, often creating a visible gap at the fracture site and requiring surgery for realignment. In contrast, non-displaced fractures, where bones remain in their proper position, are more common and can typically be treated with cast or splint.
Open vs. closed shoulder fractures
Open fractures occur when the broken bone pierces the skin. This piercing increases the risk of infections and complications from the open wound. Closed fractures are contained within the soft tissue covering the fractured bone and do not involve the bone piercing through the skin.

What causes Shoulder Fractures?

Fractures to the shoulder typically result from sudden, direct impacts to the shoulder with significant force, such as those occurring during falls, collisions, or motor vehicle accidents.

For instance, when scapula fractures (fractures to the shoulder blade) occur, they are typically the result of particularly high-energy trauma, such as involvement in a high-speed motor vehicle collision that can result in chest injuries as well.

What are the symptoms of Shoulder Fractures?

The cause of bone fractures can vary and most frequently occurs when excessive force is exerted on the bone, often through twisting or direct impact. Some causes include falls, injuries, repetitive motions leading to stress fractures, and diseases that weaken the bones, like osteoporosis or bone cancer.

In general, someone with a shoulder fracture may experience symptoms like shoulder pain, swelling, bruising or discolouration, limited mobility in the shoulder, and possibly a noticeable bump or deformity. Additionally, if the shoulder feels slipping out of the socket, it could indicate a dislocation.

It is important to note that individuals should not try to manipulate their shoulders back into place if there is a noticeable bump or slipping of the shoulders after trauma. Seeking immediate medical attention from an experienced orthopaedic specialist is essential if you suspect a shoulder fracture, dislocation or other shoulder injury.

Depending on the location of the fracture, some symptoms might be more apparent in certain areas.

Type of Fracture	Symptoms
Clavicle Fracture	Swelling and bruising around the middle of the collarbone. A bump may be noticeable, which is the broken ends of the bone pushing against the skin. Limited ability to move the shoulder, although not as severe as proximal humerus fractures.
Proximal Humerus Fracture	A severely swollen shoulder. Very limited movement of the shoulder. Bruising is visible around the top of the arm.
Scapular Fracture	Severe bruising about the shoulder blade.

Are Shoulder Fractures painful?

Fracturing any of the bones in the shoulder can significantly limit mobility and result in severe pain. The severity of the pain can vary depending on factors such as the type and location of the fracture. Still, it’s common for individuals with shoulder fractures to experience significant discomfort, especially when moving the shoulder or putting weight on the affected arm.

Who is at risk of Shoulder Fractures in Singapore?

Certain factors could contribute to an increased risk of shoulder fractures:

Age: Older adults, particularly those aged 65 and above, are more prone to age-related bone density loss and an increased likelihood of falls.
Osteoporosis: This condition weakens bones, making them more susceptible to fractures, including those in the shoulder.

How are Shoulder Fractures diagnosed?

Typically, an orthopaedic surgeon begins by reviewing a patient’s medical history and injury record, often initiated in the emergency room following trauma incidents like car accidents or falls. Following this assessment, one or more diagnostic tests may be conducted as well:

Physical examination: Checking for pain at the site of the fracture, swelling, deformity, and range of motion in the shoulder.
Imaging tests:

- X-rays: The primary imaging technique to confirm a fracture and determine the specific location and extent of the injury.
- CT scans: Used in more complex situations to provide detailed images and help assess the severity of the fracture.
- MRI: Sometimes employed to evaluate soft tissue damage around the shoulder, such as ligaments and tendons.

How serious are Shoulder Fractures?

The seriousness of shoulder fractures varies depending on factors like the type, location, and severity of the fracture, as well as the patient’s overall health and age. Some shoulder fractures may be relatively minor and heal with conservative treatment. However, more severe fractures or bone displacement may require surgical intervention to realign the bones and ensure proper healing.

If left untreated, shoulder fractures can lead to complications like nerve or blood vessel damage, joint instability, or chronic pain. Timely medical evaluation and appropriate treatment are essential to minimise complications and promote recovery.

What are the treatment options for Shoulder Fractures in Singapore?

Treatments for a broken shoulder vary depending on the specific bone broken and the severity of the injury. A tailored treatment plan will be recommended after a thorough assessment by Dr Jerry Chen, experienced Consultant Orthopaedic Surgeon and Medical Director at Alps Orthopaedic Centre.

Non-surgical treatments
For non-displaced fractures, patients will likely be advised to use ice, wear an arm sling or cast for immobilisation, and take pain medication. Physical therapy may also be recommended to help patients regain shoulder mobility.

Surgical treatments
In severe cases where conservative treatments are inadequate, surgery may be required to fix a fractured shoulder. There are two common types of shoulder fracture surgeries: open reduction and internal fixation, as well as arthroplasty.

Open reduction and internal fixation (ORIF)
This surgical procedure is used to treat shoulder fractures by realigning the broken bones to their correct position and then securing them in place with internal fixation devices, namely metal plates, screws, or rods. These devices are inserted into the broken bone to hold it in place while it heals. In some cases, these fixation devices may remain permanently in the bone, while follow-up surgery may be required to remove them in others.
Arthroplasty
For some patients with severe fractures that cannot be adequately repaired by ORIF, they may require partial or total arthroplasty. Also commonly known as joint replacement surgery, arthroplasty involves replacing a damaged joint with a prosthesis (artificial joint).

Summary

In conclusion, shoulder fractures occur when bones in the shoulder region break due to trauma, causing pain, swelling, and difficulty moving the shoulder. Untreated fractures can lead to complications such as impaired healing, chronic pain, poor range of motion, nerve or blood vessel damage, and an increased risk of secondary injuries like arthritis. Timely diagnosis and specialised fracture treatment are crucial to promote proper healing and minimise the risk of long-term complications associated with shoulder fractures.

Visit Alps Orthopaedic Centre

If you have symptoms of a shoulder fracture, such as pain, swelling, and bruising, make an appointment with Dr Jerry Chen, the Medical Director and Consultant Orthopaedic Surgeon at Singapore’s Alps Orthopaedic Centre. You will receive prompt medical evaluation and specialised treatment, helping your shoulder to heal.

Frequently Asked Questions

Can Shoulder Fractures be prevented?

While it’s not always possible to prevent shoulder fractures entirely, the following general safety tips can help reduce the risk of injury:

Always wear a seatbelt while driving or seated in a vehicle
Use proper protective gear when engaging in a high-impact activity
Engage in weight-bearing exercises and ensure an adequate calcium and vitamin D intake to keep bones healthy and less prone to fractures. If you are over 65 years old or have osteoporosis, you may want to seek further medical advice.

Can I lead a normal life with Shoulder Fractures?

While a shoulder fracture may temporarily disrupt daily activities and routines, many individuals can return to a normal life with appropriate treatment and rehabilitation. Working closely with your orthopaedic surgeon is essential to ensure a good outcome and address any concerns that may arise during recovery.

Can Shoulder Fractures recur after treatment?

Once a shoulder fracture has properly healed, it typically does not recur. However, older adults may have a higher risk of recurrence due to decreased bone density and a slower healing process. Also, high-impact activities or accidents can lead to refracture, especially if the bone has not healed.

References

Cleveland Clinic. (2023). Shoulder fracture. Retrieved from https://my.clevelandclinic.org/health/diseases/shoulder-fracture
American Academy of Orthopaedic Surgeons. (n.d.). Shoulder trauma, fractures, and dislocations. OrthoInfo. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-trauma-fractures-and-dislocations/
Penn Medicine. (n.d.). Shoulder fracture diagnosis and treatment. Retrieved from https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/orthopaedics/shoulder-pain/shoulder-fracture-diagnosis-and-treatment

Has this article been insightful? Share it!

Dr Jerry Chen

MBBS (S’pore), MRCSEd, MMed (Ortho), FRCSEd (Ortho)

Fellowship-trained Consultant Orthopaedic Surgeon & Medical Director

Before starting Alps Orthopaedic Centre, Dr Jerry Chen was a Consultant at Singapore General Hospital (SGH), where he accumulated over 13 years of experience in Orthopaedic Surgery.
Dr Chen spearheaded the workgroup for Enhanced Recovery After Surgery (ERAS) for hip and knee replacement surgeries at SGH, where he successfully employed ERAS, benefiting more than 2,000 patients thus far.
Having performed over 500 surgeries in a year, he has been instrumental in helping numerous patients recover from injuries and diseases and return to their active lifestyles.
His clinical interests include Enhanced Recovery After Surgery (ERAS) for Hip and Knee, Sports Injuries, Minimally Invasive Surgery and Robotic Surgery.

Why Alps Orthopaedic Centre?

At Alps Orthopaedic Centre, we specialise in Enhanced Recovery After Surgery (ERAS). Performed as a Day Surgery, the ERAS Direct Anterior Approach in Total Hip Replacement (THR) technique as well as ERAS Total Knee Replacement (TKR), reduces the average hospitalisation stay, utilising techniques which enable the patient to suffer from less pain and recover faster. We are an Orthopaedic clinic in Singapore, which specialises in ERAS and do our utmost to enable patients to return to everyday activities as early as possible.

Our Orthopaedic clinic provides specialised diagnosis and effective treatment of musculoskeletal problems, especially Day Surgery / Enhanced Recovery After Surgery (ERAS) For Hip and Knee Surgery, Sports Injuries and Trauma Fractures. If you are considering hip or knee surgery or minimally invasive treatments, book an appointment with our experienced Consultant Orthopaedic Surgeon, Dr Jerry Chen, for a thorough assessment and treatment plan.

Our aim is to boost patient well-being, optimising every aspect of the surgical journey. By minimising the recovery period, patients are able to go back to activities that they love. The Alps team offers comprehensive financial counselling sessions to ensure our patients understand their options and make informed decisions regarding their treatment plans.

Has this article been insightful? Share it!

Dr Jerry Chen

MBBS (S’pore), MRCSEd, MMed (Ortho), FRCSEd (Ortho)

Fellowship-trained Consultant Orthopaedic Surgeon & Medical Director

Before starting Alps Orthopaedic Centre, Dr Jerry Chen was a Consultant at Singapore General Hospital (SGH), where he accumulated over 13 years of experience in Orthopaedic Surgery.
Dr Chen spearheaded the workgroup for Enhanced Recovery After Surgery (ERAS) for hip and knee replacement surgeries at SGH, where he successfully employed ERAS, benefiting more than 2,000 patients thus far.
Having performed over 500 surgeries in a year, he has been instrumental in helping numerous patients recover from injuries and diseases and return to their active lifestyles.
His clinical interests include Enhanced Recovery After Surgery (ERAS) for Hip and Knee, Sports Injuries, Minimally Invasive Surgery and Robotic Surgery.

Why Alps Orthopaedic Centre?

Has this article been insightful? Share it!

Dr Jerry Chen

MBBS (S’pore), MRCSEd, MMed (Ortho), FRCSEd (Ortho)

Fellowship-trained Consultant Orthopaedic Surgeon & Medical Director

Before starting Alps Orthopaedic Centre, Dr Jerry Chen was a Consultant at Singapore General Hospital (SGH), where he accumulated over 13 years of experience in Orthopaedic Surgery.
Having performed over 500 surgeries in a year, he has been instrumental in helping numerous patients recover from injuries and diseases of the musculoskeletal system.
As a driven and valued member, Dr Chen spearheaded the workgroup for Enhanced Recovery After Surgery (ERAS) for hip and knee replacement surgeries at SGH.
Over the course of his career at SGH, Dr Chen has successfully employed ERAS and reduced the average hospitalisation stay for hip and knee replacement surgeries.
Going through these ERAS day surgeries has benefited more than 2,000 patients thus far, enabling them to suffer from less pain and recover faster.
The Alps team is committed to providing specialised orthopaedic care tailored to your unique condition. We offer comprehensive financial counselling sessions to ensure our patients understand their options and make informed decisions regarding their treatment plans.