Xray of Shoulder showing fracture of body and spine of scapula

Fracture of Scapula With Spine Of Scapula

The Arrows have been put to show the scapular fracture.

No related posts.

Fracture Upper End Humerus Fixed With Kwires

Fracture healed uneventfully and Kwires were removed after 6 weeks of surgery

Related posts:

1. Fracture Upper End Humerus In Child Treated With Closed Reduction and Internal Fixation With K Wires
2. Fracture Humerus Upper End – Anteroposterior Xray
3. Xray of Oblique Fractrure Upper End of Humerus

Oblique Fracture Of Upper End Humerus In A Young Adult

The patient was operated for open reduction and internal fixation using PHILOS plate.

Related posts:

1. Xray of Comminuted Fracture of Upper End of Humerus
2. Fracture Of Upper End Of Humerus With Subluxation Of Humeral Head – Anteroposterior Xray
3. Fracture Humerus Upper End – Anteroposterior Xray

Fresh Fracture of Shaft of Humerus In A Patient With Previously Operated Upper End Humerus Fracture With PHILOS

There is a subluxation of the same shoulder joint too.

Related posts:

1. Xray of Comminuted Fracture of Upper End of Humerus
2. AP and Lateral Xray of Operated Patella Fracture Fixed With Screws and Tension Band Wiring
3. Fracture Upper End Of Humerus Fixed With Kwires

The xray revealed fracture of upper end of humerus and a dislocated head from the glenoid cavity.

Fracture of Upper End Humerus With Dislocation of Sholuder Joint

Open reduction and internal fixation was done with Proximal Humerus Internal Locked System (PHILOS)

[See the image below]

Posteopertive Film Showing Reduced Shoulder and Fracture Fixed With PHILOS

The patient recovered well. The fracture united and full range of movement was gained.

Related posts:

1. Intercondylar Fracture Of Humerus – Preoperative And Postoperative Xrays
2. Preoperative and Postoperative Xrays of Fracture Shaft Of Ulna In Distal Third Region
3. Preoperative and Postoperative Xrays of Spiral Fracture of Shaft Femur In 11 Year Old Child

The xray he carried revealed a comminuted fracture along with subluxation of the glenohumeral joint.

He was offered open reduction and internal fixation as treatment but patient refused operative intervention.

He has been put in plaster of Paris cast.

Related posts:

1. Fracture Humerus Upper End – Anteroposterior Xray
2. Xray of Comminuted Fracture of Upper End of Humerus
3. Xray of Oblique Fractrure Upper End of Humerus

Note: The xray is not a good quality. But it was interesting xray, therefore I could not resist myself from publishing.

Related posts:

1. Post Reduction Xray Of Shoulder Dislocation With Fracture of Greater Tuberosity
2. Xray of Fracture of Lateral Condyle of Humerus In Adult
3. Xray of United Fracture of Lateral Condyle Of Humerus

The patient was treated with closed reduction under general anesthesia.

The above xray is taken after the closed reduction. The patient was advised fixation for greater tuberosity fracture but refused.

Related posts:

1. Xray Of Chip Fracture Of Greater Tuberosity of Humerus
2. Xrays of Fracture Dislocation of Shoulder – Preoperative and Postoperative Films
3. Acute Dislocation of Shoulder – Clinical Presentation

While elderly patients can be treated on conservatively The fractures in an adult on the other hand would require operative treatment owing to the increased demands and active life style.

Most of these fractures in children also unite on conservative treatment. Only those fractures which are severely displaced would need an operative intervention.

The following xrays are of  10 years old child who suffered fracture of upper end of humerus after he fell from height while he was flying a kite.

The fracture is severely displaced as can be seen in the picture. The patient was treated with closed reduction and crossed K wire fixation.

The patient has been followed for 4 weeks and the fracture has united. The Kwires have been removed and patient has been put on physiotherapy for shoulder mobilisation.

Author Note

The Kwires are bit protruding inside the joint.

Related posts:

1. Distal Radius Type II Epiphyseal Slip Treated By Closed Reduction & Kwire Fixation
2. Intraarticular Fracture Distal Tibia and Distal Fibula Fracture Treated By Open Reduction And Internal Fixation
3. Anterior Dislocation of Hip Treated By Closed Reduction

Epiphyseal Lines
An ossification pattern of the scapula should be known to avoid this confusion. At birth, the body and spine of scapula form one ossified mass, with the coracoid, acromion, glenoid, and inferior angle all being cartilaginous.

At 3 to 18 months, a center of ossification,  appears at the mid-coracoid.

At 7 to 10 years, the coracoid base, including the upper third of the glenoid, appears.Sometimes called a subcoracoid bone and it joins the rest of the coracoid at 14 to 16 years.

An ossification center at the tip and shell-like center of the medial apex of the coracoid may appear at the same time and go on to fuse between 18 and 25 years.

Two or three acromial centers form at 14 to 16 years of age, coalesce at 19 years, and fuse to the spine between 20 and 25 years of age.

Failure of fusion with persistence of one ossification center past 25 years of age creates what is known as an os acromiale. [see below]

The glenoid fossa ossifies from four sources:

1. The coracoid base (including the upper third of the glenoid)
2. The deep portion of the coracoid process,
3. The body,
4. The lower pole

Between 8 and 13 years of age, the glenoid border may show evidence of irregular ossification.

At the inferior angle of the scapula, an ossification center appears at 15 and fuses at 20 years of age; the vertebral border center appears from 16 to 18 and fuses by 25 years of age.

The ossification centers may be asymmetric, and thus comparison films may not be helpful.

OS Acromiale
Clinically, os acromiale is the best known separate bone, resulting from failure of the adjacent ossification centers to coalesce. It can simulate an acromial fracture.

The open epiphyseal line occurs at the level of the acromioclavicular joint.

The unfused apophysis is present in 2.7% of randomly selected adults and, when present, is bilaterally symmetric in 60%.

Factors favoring the diagnosis of os acromiale over fracture are

• Bilateral occurrence
• Rounded borders with uniform space
• Bony ossification center is  even with or above the posterior acromion on the anteroposterior view.

Glenoid Hypoplasia

Hypoplasia of the glenoid may resemble and thus be misinterpreted as an impaction fracture of the glenoid.

Marked glenoid retroversion is also seen with this condition. It usually takes a benign course.

Related posts:

1. Scapular Fractures
2. Fractures of Proximal Humerus
3. Fractures of The Clavicle-Part II