CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

21452Ugur_TiftikciCurrent_Consept_in_adults.kapak

EMERGENCY MANAGEMENTOF SHOULDER FRACTURES AND DISLOCATIONS

Cihan Ergün1 İsmail Tüter2

1Ankara Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
2İstanbul Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Türkiye

Ergün C, Tüter İ. Emergency Management of Shoulder Fractures and Dislocations. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.3-16.

ABSTRACT

The shoulder joint, the most mobile joint in the human body, possesses a wide range of motion, making it particularly susceptible to various injuries, including fractures and dislocations. This review provides a detailed analysis of the anatomy, epidemiology, injury types, emergency management strategies, and post-injury care processes associated with shoulder fractures and dislocations. Structurally, the shoulder comprises a complex system of muscles, tendons, and ligaments that support its mobility, along with three primary bones: the humerus, scapula, and clavicle. While this structure facilitates extensive motion, it also heightens injury risks, especially among high-risk groups such as elderly individuals and athletes.

The review assesses the prevalence of shoulder injuries, including proximal humerus fractures, scapular fractures, and clavicular fractures, linking these injuries to risk factors such as osteoporosis and high-energy impact trauma. It categorizes shoulder dislocations into various types, with a specific focus on the commonly occurring anterior dislocation while briefly addressing less frequent types such as posterior, inferior, and multidirectional dislocations.

In emergency care, the accurate determination of injury type and severity requires a comprehensive patient history, detailed clinical examination, and the use of diagnostic imaging modalities such as X-rays, CT scans, and MRIs. Closed reduction techniques play a pivotal role in emergency interventions for dislocations, with success rates dependent on the method employed. Techniques such as the Hippocratic and Kocher methods are explored, emphasizing the role of sedation in pain reduction during these procedures.

Surgical approaches, including open reduction and arthroscopic repair, are often necessary for complex or untreated cases. Post-reduction management includes immobilization, early rehabilitation initiation, and the prevention of complications such as neurovascular injury, recurrent dislocations, and adhesive capsulitis. The American Academy of Orthopaedic Surgeons (AAOS) guidelines highlight the importance of timely interventions and rehabilitation in achieving successful outcomes.

Case studies in athletes reveal that early surgical intervention significantly reduces the risk of recurrent dislocations. Additionally, this review underscores the importance of a multidisciplinary and culturally sensitive approach in improving outcomes and mitigating complication risks in diverse patient populations and healthcare settings.

Keywords: Shoulder injuries; Fractures; Dislocations; Rehabilitation; Reduction

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