Trauma of the shoulder and elbow

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For shoulder and elbow fractures the best functional results arise from anatomic reduction and early motion of the joint. If the fracture cannot be reduced or held, then open reduction and internal fixation should be considered. Surgery should be performed with minimal soft tissue disruption to allow early joint motion. Concerning the shoulder, there is a trend toward the use of pins and tension band wire techniques, although plating can be used where there is good quality bone. Hemiarthroplasty is recommended for those fractures in which reconstruction of the humeral head is not possible. Humeral shaft fractures can usually be treated nonoperatively, but if surgery is required, either plating or intramedullary fixation can be considered. With supracondylar fractures in children, percutaneous pins are increasingly popular; however, in adults with elbow fractures, rigid plate fixation offers more security and allows for early joint motion. The management of various fractures is discussed and the recent literature in those areas is reviewed.

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