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Orthopaedics
Shoulder
Built from Orthopedic Trauma Essentials
What’s inside
6 sections · 142 slides
Overview
- What this topic is about
- Bones of the shoulder girdle
- Why the shoulder girdle is a hard trauma problem
- The four injury families
Clavicle Fractures
Operate or not, with what implant, in whom, and what to do about the hardware afterwards
- The clavicle, seen from above
- Where the clavicle breaks
- Displaced midshaft clavicle fracture
- The old rule, and the new question
- Nonoperative treatment of a clavicle fracture
- What the randomized trial showed
- What the pooled evidence adds
- Where the advantage fades
- What surgery costs
- Operate or sling: the honest summary
- Who is surgery most defensible in?
- Plate or rod: what is being argued about
- Plate fixation of the clavicle
- Intramedullary fixation of the clavicle
- What the implant comparisons show
- Choosing between them
- Athletes: does the calculation change?
- What the athlete data show
- Athletes: the practical position
- Why hardware removal keeps coming up
- From plate to refracture
- What the refracture evidence says
- Removing hardware: the rules that follow
- The numb patch after clavicle surgery
- What the nerve studies found
- The level I answer on nerve sparing
Acromioclavicular Joint Injuries
Which grade needs an operation, when to do it, with what construct, and how long to protect it
- Ligaments that suspend the clavicle from the scapula
- What holds the collarbone down
- Acromioclavicular joint separation
- Comparing both shoulders under load
- How these injuries are graded
- Why type III is the argument
- An attempt to split type III in two
- What the type III trials show
- The randomized-trials-only meta-analysis
- When surgery is still defensible in type III
- Early or late: why timing is argued
- What the timing evidence says
- Chronic injuries are a reconstruction problem
- Reconstruction alone or with hardware?
- Cutting away the end of the clavicle
- How the stabilization techniques compare
- What the technique comparisons found
- No single technique wins
- Reading the technique comparison table
- Comparative characteristics of common AC stabilization techniques
- Complications and reoperation profile by technique
- Protecting the repair afterwards
- An evidence gap, honestly stated
- Reading the immobilization table
- Immobilization strategies and their rationale
- Immobilization strategies and reported time frames
- The defensible immobilization plan
Scapula Fractures
Displacement thresholds, the floating shoulder, glenoid step-off, and the injury that unhitches the limb
- How often the shoulder blade breaks
- Why some still need fixing
- A scapular fracture on plain film and on 3D CT
- Why plain films are not enough
- The three measurements, in plain terms
- The thresholds people quote
- Why these are markers, not commandments
- Deformity you can measure is not always deformity that hurts
- The scapula decision, summarised
- The floating shoulder
- What the floating shoulder evidence shows
- Who needs both bones fixed
- Floating shoulder: the position
- Fractures into the socket
- Getting to the fracture
- How much step-off is too much
- The glenoid answer
- When the shoulder blade is torn off the chest wall
- 88%
- Catching it in time
- What gets treated first
- The unresolved question
Shoulder Dislocations
Anterior, posterior, chronic and seizure-related - and the bone loss that decides what will hold
- The commonest large joint to come out
- Anterior shoulder dislocation
- Immobilising in external rotation: the idea
- What happened when it was tested
- The pragmatic standard
- How often it comes back in the young
- Who is high risk
- The hyperlaxity trap
- Bone loss on both sides of the joint
- Bankart and Hill-Sachs lesions after dislocation
- How much socket can be lost
- Sorting out the bone loss
- Anterior dislocation: the summary
- The dislocation that gets missed
- Reverse Hill-Sachs lesion in posterior dislocation
- The imaging rule
- The dent that decides treatment
- Treating by defect size
- What those operations do
- Recurrent posterior instability
- Posterior dislocation: the summary
- When a dislocation is left in place
- What the chronic-dislocation studies show
- What can be done, and when
- Chronic posterior dislocation
- Is benign neglect still acceptable?
- Why a seizure breaks shoulders differently
- How a seizure drives the head backwards
- What the seizure series report
- Fracture-dislocations and the blood supply
- When to replace rather than fix
- The vicious cycle to break
- Seizure control beats surgical technique
- Timing surgery around the seizures
- After the operation
- Reading the seizure treatment algorithm
- Evidence-based stepwise treatment algorithm for seizure-related shoulder injuries
- Seizure-related injuries: the summary
Bringing It Together
What to carry away from the shoulder girdle
- Takeaways: clavicle and AC joint
- Takeaways: scapula and dislocation
- Three habits worth keeping
- Where the evidence is genuinely thin
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- Orthopedic Trauma Essentials 2026