Shoulder fracture is a term encompassing several types of fractures developing in the shoulder region. Fractures of the distal clavicle, the scapula, and the proximal humerus are the three most important types. Trauma, either through falls (typical in the elderly population) or high-velocity trauma (for example, in contact sports or accidents) is the universal risk factor and cause of all shoulder fractures. The diagnosis rests on a thorough patient history and a detailed physical examination, whereas imaging studies such as plain radiography and computed tomography (CT) are used to confirm the exact type.
Shoulder fractures are further differentiated by the involvement of specific anatomical sites . Among the most commonly encountered shoulder fractures in the clinical practice are proximal humerus and humeral head fractures, mainly seen in the elderly population   . In fact, up to 70% of all fractures of the humeral head are seen in patients over 60 years of age . The mechanism of injury could be a low-energy trauma after falling on the shoulder. A high-energy trauma that occurs in vehicle accidents and during contact sports is a frequent cause in younger patients   . In addition to reduced mobility of the shoulder and the relevant arm, accompanying manifestations are the pain and swelling . In some patients, manifestations such as digital ischemia and hypotension can develop in the case of vascular injury . Distal clavicle fractures, which are diagnosed in patients younger than 25 years of age in virtually all cases, is an important type of shoulder fracture that stems from high-energy trauma  . The clinical presentation of clavicle fractures is centered around the typical stance of the patient, with the arm usually being placed in adduction . Fracture of the scapula is also an important representative of the shoulder injury, although it is quite rare compared to proximal humerus and clavicle fractures . Scapular fractures are rarely isolated, meaning that severe trauma is usually the underlying cause .
When it comes to shoulder fractures, the two critical components of the workup are a thorough patient history and a proper physical examination     . Patients must be asked about the events that preceded the injury and the exact mechanism of trauma, as well as the location of impact, which can be of great use for establishing a presumptive diagnosis. Once enough information is gathered during history taking, physicians should conduct a careful physical assessment. Clinical suspicion is solidified through inspection, palpation, and the assessment of joint mobility. Some authors advocate that this examination should be done when the patient is standing, the reason being that scapular and other fractures can be missed in the supine position . In order to make a definite diagnosis, however, imaging studies need to be employed    . Plain radiography is the first technique that should be used and two views (sometimes even three) are necessary to determine the exact location and extent of the injury, namely anteroposterior view, a scapular view, and an axial view  . If inconclusive findings are obtained with plain radiography, computed tomography (CT) is a superior study that provides a definite description of the fracture type and severity   . For patients with suspected vascular compromise, digital subtraction angiography (DSA) must be conducted .