Fractures and dislocations of the shoulder girdle

Fractures and dislocations involving the shoulder girdle are common. If these injuries occur after high-energy trauma, initial assessment must follow Advanced Trauma Life Support™ (ATLS)™ guidelines to identify associated life-threatening injuries. Physical examination must include a thorough neurovascular assessment of the upper limb, with particular attention to the axillary nerve and brachial plexus because they are often damaged in injuries to the shoulder girdle. Knowledge of the relevant anatomy and accurate radiological evaluation help classify the severity of the fracture or dislocation. Classification of the injury helps guide treatment and indicate prognosis. Most fractures and dislocations of the shoulder girdle are managed with a brief period of immobilization followed by early, progressive mobilization of the entire upper limb to prevent stiffness. Surgical treatment is appropriate in some patients and various techniques are used to achieve reduction of the fracture or dislocation and maintain reduction by internal fixation. Complications may occur as a result of initial injury or after treatment of the fracture or dislocation.