What is a shoulder fracture?

Shoulder fractures correspond to bone injuries concerning the proximal humerus, clavicle or scapula, generally related to trauma. These fractures require specialized management to optimize functional recovery.

The therapeutic strategy depends on displacement, fracture type, patient age and functional expectations. The objective is to obtain consolidation in good axis while limiting stiffness.

Types and locations of fractures

Proximal humerus

Fractures of tuberosities, surgical or anatomical neck. The most frequent and complex, requiring precise displacement assessment.

Clavicle

Fractures of the middle third (most frequent), outer or inner third. Often related to falls or direct trauma.

Scapula

Fractures of the neck, body or glenoid. Rarer but often associated with high-energy trauma.

Mechanisms and causes

Direct trauma

Falls on the shoulder, direct blows, road traffic accidents. High-energy trauma is more frequent in young patients.

Risk factors: Advanced age, osteoporosis, risky sports activities, work accidents.

Bone fragility

Osteoporosis significantly increases fracture risk, even for minor trauma. Shoulder fractures are frequent in elderly people.

Prevention: Osteoporosis treatment, fall prevention, strengthening exercises.

Symptoms and manifestations

Acute pain

Intense and immediate pain after trauma, often disabling and aggravated by movements. Pain may persist for several weeks.

Characteristics: Localized pain, often pulsatile, aggravated by palpation and movements.

Deformation and impairment

Sometimes visible local deformation, swelling, hematoma. Significant functional impairment with impossibility to mobilize the shoulder.

Warning signs: Major deformation, skin lesions, neurological or vascular disorders.

Diagnosis and evaluation

Clinical examination

• Inspection: Deformation, swelling, hematoma, skin lesions
• Palpation: Localized pain, crepitus, abnormal mobility
• Neurological examination: Search for associated nerve lesions
• Vascular examination: Pulses, coloration, temperature

Imaging examinations

X-rays

Reference examination to visualize the fracture, assess displacement and plan treatment

CT scan

Complementary examination for complex fractures, three-dimensional assessment and surgical planning

MRI

Specialized examination to assess soft tissue lesions and vascular or neurological complications

Therapeutic options

Conservative treatment

Conservative treatment is preferred for non-displaced or slightly displaced fractures, in elderly patients or with surgical contraindications.

• Immobilization: Sling, splint, orthopedic vest according to fracture type
• Analgesics: Pain control adapted to intensity
• Surveillance: Regular radiological controls to verify consolidation
• Rehabilitation: Progressive mobilization according to consolidation

Surgical treatment

Osteosynthesis is indicated for displaced, unstable fractures or in young patients with high functional expectations.

Surgical indications:

• Displaced fractures with pseudarthrosis risk
• Tuberosity involvement compromising function
• Associated skin or neurovascular lesions
• Young patients with high functional expectations

Plate osteosynthesis

Fixation by plate and screws for complex fractures, allowing anatomical reduction and stable fixation.

Nail osteosynthesis

Fixation by intramedullary nail for certain humeral fractures, less invasive technique.

Shoulder prosthesis

Prosthetic replacement for complex irreparable fractures, particularly in elderly patients.

Learn more about osteosynthesis →

Post-operative rehabilitation

Rehabilitation after shoulder fracture is essential to optimize functional recovery and prevent complications.

Phase 1: Immobilization (2-4 weeks)

Variable immobilization according to fracture type and surgical procedure performed

Phase 2: Mobilization (3-6 weeks)

Early passive mobilizations if stable, active mobilizations from 3-4 weeks

Phase 3: Strengthening (6-12 weeks)

Progressive strengthening from 6-8 weeks, usual radiological consolidation in 6-12 weeks

Objectives: Range recovery, muscle strengthening, return to daily and professional activities.

Possible complications