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Depending on the type of fracture and the bone involved, shoulder fractures can be treated with open surgery, minimally invasive technique (MIPPO), percutaneous technique, and arthroscopy (keyhole surgery)
Almost all fractures around the shoulder can be managed by open surgery. In open surgery technique, large skin incisions are given, the muscle dissected and retracted to have complete visualization of the fracture site. We prefer open surgery for humeral head fractures wherein multiple fragments need to be aligned normally to restore the normal shape of the head, for scapula fractures, for clavicle (collar bone) fracture that are multiple in nature.
Elderly patients with articular fractures of the humeral head that are not grossly displaced can be managed with percutaneous K-wires due to the presence of poor quality bones, which cannot hold the screws.
MIPPO is a technique of surgery in which the skin incisions are smaller, muscle dissection is minimal and the fracture fragments are not disturbed in order to avoid disturbing the healing environment at the fracture surface. The advantage of this technique is that fracture healing better and patients have less pain due to minimal dissection.
Some fractures of the shoulder joint are very small and occur in the form of chip fractures (avulsions) wherein a fragment of bone is displaced along with the attached soft tissue (tendon or labrum). An open surgery in such fractures involves extensive dissection and inadequate visualization owing to the small size of fractures. The advantage of arthroscopy is that it allows fixation of such fractures through two-three small skin incisions and allow proper visualization due to the magnification of the arthroscope.
After surgery, patients are given analgesics for pain control and given shoulder immobilizer for 2 weeks. Gentle range of movement exercises as tolerated by the patient is started from day 1. After 2 weeks, suture removal is done and patients are encouraged to increase their shoulder movements. Strengthening of deltoid and scapula muscles is started after 1 month and patients can do heavy activities 2-3 months after the surgery. However, one must note that fracture union requires 6-8 weeks on an average after surgery and hence any strenuous activity is not encouraged during this period
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