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Semin Musculoskelet Radiol 2019; 23(02): 099-108
DOI: 10.1055/s-0038-1677465
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fractures Around the Shoulder: Radiologic Update on Surgical Fixation Techniques

Kara Gaetke-Udager
1   Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
,
Corrie M. Yablon
1   Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
› Author Affiliations
Further Information

Publication History

Publication Date:
29 March 2019 (online)

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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.

Keywords

proximal humerus fracture - osseous Bankart lesion - Hill-Sachs lesion - distal clavicle fracture
 

  • References

  • 1 Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37 (08) 691-697
    CrossrefPubMedGoogle Scholar
  • 2 Codman EA. The Shoulder; Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa. Boston, MA: T. Todd; 1934
    Google Scholar
  • 3 Neer II CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970; 52 (06) 1077-1089
    CrossrefPubMedGoogle Scholar
  • 4 Neer II CS. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg 2002; 11 (04) 389-400
    CrossrefPubMedGoogle Scholar
  • 5 Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoenberg N. The Neer classification system for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg Am 1993; 75 (12) 1745-1750
    CrossrefPubMedGoogle Scholar
  • 6 Siebenrock KA, Gerber C. The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am 1993; 75 (12) 1751-1755
    CrossrefPubMedGoogle Scholar
  • 7 Sandstrom CK, Kennedy SA, Gross JA. Acute shoulder trauma: what the surgeon wants to know. Radiographics 2015; 35 (02) 475-492
    CrossrefPubMedGoogle Scholar
  • 8 Expert Panel on Musculoskeletal Imaging; Amini B, Beckmann NM, Beaman FD, et al. ACR Appropriateness Criteria Shoulder Pain—Traumatic. 2017; Available at: https://acsearch.acr.org/docs/69433/Narrative/ . Accessed September 22, 2018
    PubMed
  • 9 Sidor ML, Zuckerman JD, Lyon T, Koval K, Schoenberg N. Classification of proximal humerus fractures: the contribution of the scapular lateral and axillary radiographs. J Shoulder Elbow Surg 1994; 3 (01) 24-27
    CrossrefPubMedGoogle Scholar
  • 10 Robinson BC, Athwal GS, Sanchez-Sotelo J, Rispoli DM. Classification and imaging of proximal humerus fractures. Orthop Clin North Am 2008; 39 (04) 393-403 , v v.
    CrossrefPubMedGoogle Scholar
  • 11 Castagno AA, Shuman WP, Kilcoyne RF, Haynor DR, Morris ME, Matsen FA. Complex fractures of the proximal humerus: role of CT in treatment. Radiology 1987; 165 (03) 759-762
    CrossrefPubMedGoogle Scholar
  • 12 Mora Guix JM, Gonzalez AS, Brugalla JV, Carril EC, Baños FG. Proposed protocol for reading images of humeral head fractures. Clin Orthop Relat Res 2006; 448 (448) 225-233
    CrossrefPubMedGoogle Scholar
  • 13 Bernstein J, Adler LM, Blank JE, Dalsey RM, Williams GR, Iannotti JP. Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg Am 1996; 78 (09) 1371-1375
    CrossrefPubMedGoogle Scholar
  • 14 Sallay PI, Pedowitz RA, Mallon WJ, Vandemark RM, Dalton JD, Speer KP. Reliability and reproducibility of radiographic interpretation of proximal humeral fracture pathoanatomy. J Shoulder Elbow Surg 1997; 6 (01) 60-69
    CrossrefPubMedGoogle Scholar
  • 15 Sjödén GO, Movin T, Aspelin P, Güntner P, Shalabi A. 3D-radiographic analysis does not improve the Neer and AO classifications of proximal humeral fractures. Acta Orthop Scand 1999; 70 (04) 325-328
    CrossrefPubMedGoogle Scholar
  • 16 Berger PE, Ofstein RA, Jackson DW, Morrison DS, Silvino N, Amador R. MRI demonstration of radiographically occult fractures: what have we been missing?. Radiographics 1989; 9 (03) 407-436
    CrossrefPubMedGoogle Scholar
  • 17 Handoll H, Brealey S, Rangan A. , et al. The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial—a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults. Health Technol Assess 2015; 19 (24) 1-280
    PubMedGoogle Scholar
  • 18 Guy P, Slobogean GP, McCormack RG. Treatment preferences for displaced three- and four-part proximal humerus fractures. J Orthop Trauma 2010; 24 (04) 250-254
    CrossrefPubMedGoogle Scholar
  • 19 Handoll HH, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 2015; (11) CD000434
    PubMedGoogle Scholar
  • 20 Murray IR, Amin AK, White TO, Robinson CM. Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br 2011; 93 (01) 1-11
    PubMedGoogle Scholar
  • 21 Nowak LL, Dehghan N, McKee MD, Schemitsch EH. Plate fixation for management of humerus fractures. Injury 2018; 49 (Suppl. 01) S33-S38
    CrossrefPubMedGoogle Scholar
  • 22 Seyhan M, Kocaoglu B, Nalbantoglu U, Aydin N, Guven O. Technique of Kirschner wire reduction and fixation of displaced two-part valgus angulated proximal humerus fractures at the surgical neck. J Orthop Trauma 2012; 26 (06) e46-e50
    CrossrefPubMedGoogle Scholar
  • 23 Austin DC, Torchia MT, Cozzolino NH, Jacobowitz LE, Bell JE. Decreased reoperations and improved outcomes with reverse total shoulder arthroplasty in comparison to hemiarthroplasty for geriatric proximal humerus fractures: a systematic review and meta-analysis. J Orthop Trauma 2018
    PubMedGoogle Scholar
  • 24 Brunner F, Sommer C, Bahrs C. , et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 2009; 23 (03) 163-172
    CrossrefPubMedGoogle Scholar
  • 25 Tepass A, Rolauffs B, Weise K, Bahrs SD, Dietz K, Bahrs C. Complication rates and outcomes stratified by treatment modalities in proximal humeral fractures: a systematic literature review from 1970–2009. Patient Saf Surg 2013; 7 (01) 34
    CrossrefPubMedGoogle Scholar
  • 26 Petrigliano FA, Bezrukov N, Gamradt SC, SooHoo NF. Factors predicting complication and reoperation rates following surgical fixation of proximal humeral fractures. J Bone Joint Surg Am 2014; 96 (18) 1544-1551
    CrossrefPubMedGoogle Scholar
  • 27 Spross C, Platz A, Rufibach K, Lattmann T, Forberger J, Dietrich M. The PHILOS plate for proximal humeral fractures—risk factors for complications at one year. J Trauma Acute Care Surg 2012; 72 (03) 783-792
    CrossrefPubMedGoogle Scholar
  • 28 Boesmueller S, Wech M, Gregori M. , et al. Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures. Injury 2016; 47 (02) 350-355
    CrossrefPubMedGoogle Scholar
  • 29 Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams Jr GR. Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. J Bone Joint Surg Am 2009; 91 (10) 2492-2510
    PubMedGoogle Scholar
  • 30 Goss T. Frequency of scapular fractures. In: Rockwood CA, Matsen FA, Wirth MA. , et al, eds. Fractures of the Scapula. 3rd ed. Philadelphia, PA: Saunders; 2004: 413-454
    Google Scholar
  • 31 Sheehan SE, Gaviola G, Gordon R, Sacks A, Shi LL, Smith SE. Traumatic shoulder injuries: a force mechanism analysis-glenohumeral dislocation and instability. AJR Am J Roentgenol 2013; 201 (02) 378-393
    CrossrefPubMedGoogle Scholar
  • 32 Tuček M, Chochola A, Klika D, Bartoníček J. Epidemiology of scapular fractures. Acta Orthop Belg 2017; 83 (01) 8-15
    PubMedGoogle Scholar
  • 33 Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand 1995; 66 (05) 395-397
    CrossrefPubMedGoogle Scholar
  • 34 Provencher MT, Bhatia S, Ghodadra NS. , et al. Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am 2010; 92 (Suppl. 02) 133-151
    CrossrefPubMedGoogle Scholar
  • 35 Bloom MH, Obata WG. Diagnosis of posterior dislocation of the shoulder with use of Velpeau axillary and angle-up roentgenographic views. J Bone Joint Surg Am 1967; 49 (05) 943-949
    CrossrefPubMedGoogle Scholar
  • 36 Maquieira GJ, Espinosa N, Gerber C, Eid K. Non-operative treatment of large anterior glenoid rim fractures after traumatic anterior dislocation of the shoulder. J Bone Joint Surg Br 2007; 89 (10) 1347-1351
    PubMedGoogle Scholar
  • 37 Salomonsson B, von Heine A, Dahlborn M. , et al. Bony Bankart is a positive predictive factor after primary shoulder dislocation. Knee Surg Sports Traumatol Arthrosc 2010; 18 (10) 1425-1431
    CrossrefPubMedGoogle Scholar
  • 38 Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am 2000; 82 (01) 35-46
    CrossrefPubMedGoogle Scholar
  • 39 Spiegl UJ, Ryf C, Hepp P, Rillmann P. Evaluation of a treatment algorithm for acute traumatic osseous Bankart lesions resulting from first time dislocation of the shoulder with a two year follow-up. BMC Musculoskelet Disord 2013; 14: 305
    CrossrefPubMedGoogle Scholar
  • 40 Millett PJ, Horan MP, Martetschläger F. The “bony Bankart bridge” technique for restoration of anterior shoulder stability. Am J Sports Med 2013; 41 (03) 608-614
    CrossrefPubMedGoogle Scholar
  • 41 Porcellini G, Campi F, Paladini P. Arthroscopic approach to acute bony Bankart lesion. Arthroscopy 2002; 18 (07) 764-769
    CrossrefPubMedGoogle Scholar
  • 42 Pagnani MJ. Open capsular repair without bone block for recurrent anterior shoulder instability in patients with and without bony defects of the glenoid and/or humeral head. Am J Sports Med 2008; 36 (09) 1805-1812
    CrossrefPubMedGoogle Scholar
  • 43 Matton D, Van Looy F, Geens S. Recurrent anterior dislocations of the shoulder joint treated by the Bristow-Latarjet procedure. Historical review, operative technique and results. Acta Orthop Belg 1992; 58 (01) 16-22
    PubMedGoogle Scholar
  • 44 Longo UG, Loppini M, Rizzello G, Ciuffreda M, Maffulli N, Denaro V. Latarjet, Bristow, and Eden-Hybinette procedures for anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy 2014; 30 (09) 1184-1211
    CrossrefPubMedGoogle Scholar
  • 45 Mizuno N, Denard PJ, Raiss P, Melis B, Walch G. Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg 2014; 23 (11) 1691-1699
    CrossrefPubMedGoogle Scholar
  • 46 Provencher MT, Frank RM, Leclere LE. , et al. The Hill-Sachs lesion: diagnosis, classification, and management. J Am Acad Orthop Surg 2012; 20 (04) 242-252
    CrossrefPubMedGoogle Scholar
  • 47 Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 2007; 23 (09) 985-990
    CrossrefPubMedGoogle Scholar
  • 48 Gowd AK, Liu JN, Cabarcas BC. , et al. Management of recurrent anterior shoulder instability with bipolar bone loss: a systematic review to assess critical bone loss amounts. Am J Sports Med 2018; 363546518791555
    PubMedGoogle Scholar
  • 49 Kaar SG, Fening SD, Jones MH, Colbrunn RW, Miniaci A. Effect of humeral head defect size on glenohumeral stability: a cadaveric study of simulated Hill-Sachs defects. Am J Sports Med 2010; 38 (03) 594-599
    CrossrefPubMedGoogle Scholar
  • 50 Connolly J. Humeral head defects associated with shoulder dislocation: their diagnostic and surgical significance. Instr Course Lect 1972; 21: 42-54
    PubMedGoogle Scholar
  • 51 Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-Sachs “remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy 2008; 24 (06) 723-726
    CrossrefPubMedGoogle Scholar
  • 52 Koo SS, Burkhart SS, Ochoa E. Arthroscopic double-pulley remplissage technique for engaging Hill-Sachs lesions in anterior shoulder instability repairs. Arthroscopy 2009; 25 (11) 1343-1348
    CrossrefPubMedGoogle Scholar
  • 53 Wolf EM, Arianjam A. Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2- to 10-year follow-up and incidence of recurrence. J Shoulder Elbow Surg 2014; 23 (06) 814-820
    CrossrefPubMedGoogle Scholar
  • 54 Boileau P, O'Shea K, Vargas P, Pinedo M, Old J, Zumstein M. Anatomical and functional results after arthroscopic Hill-Sachs remplissage. J Bone Joint Surg Am 2012; 94 (07) 618-626
    CrossrefPubMedGoogle Scholar
  • 55 Deutsch AA, Kroll DG. Decreased range of motion following arthroscopic remplissage. Orthopedics 2008; 31 (05) 492
    PubMedGoogle Scholar
  • 56 Diklic ID, Ganic ZD, Blagojevic ZD, Nho SJ, Romeo AA. Treatment of locked chronic posterior dislocation of the shoulder by reconstruction of the defect in the humeral head with an allograft. J Bone Joint Surg Br 2010; 92 (01) 71-76
    CrossrefPubMedGoogle Scholar
  • 57 Miniaci A, Gish MW. Management of anterior glenohumeral instability associated with large Hill-Sachs defects. Tech Shoulder Elbow Surg 2004; 5 (03) 170-175
    CrossrefPubMedGoogle Scholar
  • 58 Kazel MD, Sekiya JK, Greene JA, Bruker CT. Percutaneous correction (humeroplasty) of humeral head defects (Hill-Sachs) associated with anterior shoulder instability: a cadaveric study. Arthroscopy 2005; 21 (12) 1473-1478
    CrossrefPubMedGoogle Scholar
  • 59 Re P, Gallo RA, Richmond JC. Transhumeral head plasty for large Hill-Sachs lesions. Arthroscopy 2006; 22 (07) 798.e1-798.e4
    PubMedGoogle Scholar
  • 60 Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg 2002; 11 (05) 452-456
    CrossrefPubMedGoogle Scholar
  • 61 Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res 1994; (300) 127-132
    PubMedGoogle Scholar
  • 62 Allman Jr FL. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am 1967; 49 (04) 774-784
    CrossrefPubMedGoogle Scholar
  • 63 Neer C. Fractures of the clavicle. In: Rockwood CA, Green DP. , eds. Fractures in Adults. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1984: 707-713
    Google Scholar
  • 64 Robinson CM, Cairns DA. Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg Am 2004; 86-A (04) 778-782
    PubMedGoogle Scholar
  • 65 Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 1998; 80 (03) 476-484
    CrossrefPubMedGoogle Scholar
  • 66 Neer II CS. Fractures of the distal third of the clavicle. Clin Orthop Relat Res 1968; 58 (58) 43-50
    PubMedGoogle Scholar
  • 67 Banerjee R, Waterman B, Padalecki J, Robertson W. Management of distal clavicle fractures. J Am Acad Orthop Surg 2011; 19 (07) 392-401
    CrossrefPubMedGoogle Scholar
  • 68 Yap JJ, Curl LA, Kvitne RS, McFarland EG. The value of weighted views of the acromioclavicular joint. Results of a survey. Am J Sports Med 1999; 27 (06) 806-809
    CrossrefPubMedGoogle Scholar
  • 69 Sandstrom CK, Gross JA, Kennedy SA. Distal clavicle fracture radiography and treatment: a pictorial essay. Emerg Radiol 2018; 25 (03) 311-319
    CrossrefPubMedGoogle Scholar
  • 70 Nordqvist A, Petersson C, Redlund-Johnell I. The natural course of lateral clavicle fracture. 15 (11-21) year follow-up of 110 cases. Acta Orthop Scand 1993; 64 (01) 87-91
    PubMedGoogle Scholar
  • 71 Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury 1992; 23 (01) 44-46
    CrossrefPubMedGoogle Scholar
  • 72 Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. J Trauma 2001; 51 (03) 522-525
    CrossrefPubMedGoogle Scholar
  • 73 Fazal MA, Saksena J, Haddad FS. Temporary coracoclavicular screw fixation for displaced distal clavicle fractures. J Orthop Surg (Hong Kong) 2007; 15 (01) 9-11
    CrossrefPubMedGoogle Scholar
  • 74 Hsu KH, Tzeng YH, Chang MC, Chiang CC. Comparing the coracoclavicular loop technique with a hook plate for the treatment of distal clavicle fractures. J Shoulder Elbow Surg 2018; 27 (02) 224-230
    CrossrefPubMedGoogle Scholar
  • 75 Sajid S, Fawdington R, Sinha M. Locking plates for displaced fractures of the lateral end of clavicle: potential pitfalls. Int J Shoulder Surg 2012; 6 (04) 126-129
    CrossrefPubMedGoogle Scholar
  • 76 Kashii M, Inui H, Yamamoto K. Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res 2006; 447 (447) 158-164
    CrossrefPubMedGoogle Scholar
  • 77 Tambe AD, Motkur P, Qamar A, Drew S, Turner SM. Fractures of the distal third of the clavicle treated by hook plating. Int Orthop 2006; 30 (01) 7-10
    CrossrefPubMedGoogle Scholar
  • 78 Muramatsu K, Shigetomi M, Matsunaga T, Murata Y, Taguchi T. Use of the AO hook-plate for treatment of unstable fractures of the distal clavicle. Arch Orthop Trauma Surg 2007; 127 (03) 191-194
    CrossrefPubMedGoogle Scholar
  • 79 Boonard M, Sumanont S, Arirachakaran A. , et al. Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. Eur J Orthop Surg Traumatol 2018; 28 (06) 1065-1078
    CrossrefPubMedGoogle Scholar
  • 80 Zhang C, Huang J, Luo Y, Sun H. Comparison of the efficacy of a distal clavicular locking plate versus a clavicular hook plate in the treatment of unstable distal clavicle fractures and a systematic literature review. Int Orthop 2014; 38 (07) 1461-1468
    CrossrefPubMedGoogle Scholar