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<< Managing Shoulder Injuries in the Emergency Department: Fracture, Dislocation, and Overuse (Trauma CME)

Points and Pearls Digest

Points and Pearls Excerpt


  • Imaging for clavicle fracture should consist of a minimum of 2 views: AP view and serendipity view. The serendipity view is aimed 30°-45° cephalad.
  • While most clavicular fractures are treated conservatively, there is a recent trend toward operative intervention, especially for midshaft fractures, due to improved functional outcomes.
  • Scapular fractures—even moderately displaced ones—are often managed conservatively, though there has been a trend toward increased operative fixations in these fractures, as well.

Most Important References

  • Ponce BA, Kundukulam JA, Pflugner R, et al. Sternoclavicular joint surgery: how far does danger lurk below? J Shoulder Elbow Surg. 2013;22(7):993-999. (Prospective cohort; 49 patients) DOI: https://doi.org/10.1016/j.jse.2012.10.037
  • Slaven EJ, Mathers J. Differential diagnosis of shoulder and cervical pain: a case report. J Man Manip Ther. 2010;18(4):191-196. (Case report) DOI: https://doi.org/10.1179/106698110X12804993426884
  • Helfen T, Ockert B, Pozder P, et al. Management of prehospital shoulder dislocation: feasibility and need of reduction. Eur J Trauma Emerg Surg. 2016;42(3):357-362. (Retrospective review; 70 patients) DOI: https://doi.org/10.1007/s00068-015-0545-5
  • Lenza M, Belloti JC, Andriolo RB, et al. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev. 2014(5):CD007121. (Systematic review; 3 trials, 354 patients) DOI: https://doi.org/10.1002/14651858.CD007121.pub3
  • Neer CS, 2nd. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res. 2006;442:77-82. (Review article)
  • Sholsberg J, Jackson R. Intra-articular corticosteroid injections in acute rheumatoid monoarthritides. Emerg Med J. 2004;21(2):204. (Systematic review; 1 study, 137 patients) www.ncbi.nlm.nih.gov/pmc/articles/PMC1726294/


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