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Surgery to Repair Shoulder Joint Fractures

by Dr Steve Augustine, Orthopedic Surgeon


The Asterisk Mobile Medic unit has come a long way since 2000 when Dr. Steve Augustine and Dr. John Bodnar would literally show up at the races with their medical bag in hand. Since then, the operation has grown to become a complete on-site medical program that everyone in the industry has come to know and trust. When Dr. Augustine isn't traveling the National circuit, his day job is at the Jacksonville Orthopedic Institute Riverside Division in association with St. Vincent’s Hospital in Jacksonville, FL. He grew up in Cleveland, Ohio and in 1990 graduated from Denison University in Granville, Ohio and earned his Osteopathic Medical Degree from Ohio University in Athens, Ohio. Once he completed his orthopedic surgery residency at The Philadelphia College of Osteopathic Medicine, he sub-specialized in two areas; one in sports medicine/arthroscopy and one in shoulder reconstruction. He works as the physician advisor to the Road 2 Recovery Foundation and has been providing medical coverage for the AMA Supercross and Motocross series since 2001. He is also a founding member of the AMA medical advisory board and enjoys participating in all action sports particularly motocross, as well as jet skiing, wake boarding, snow boarding and mountain biking. That's all we really know about the guy. - Virtual trainer

If you race, hopefully this is the only time you will see Dr. Augustine's face!

The Shoulder Nail Plate
It's been called the unsolved fracture. That's because there hasn't been an ideal way to repair a badly broken shoulder joint. But Dr. Stephen Augustine, an orthopedic surgeon at St. Vincent's Medical Center, is using a new device and technique that comes close. The shoulder nail plate system solves the technical problem of pulling the broken pieces of bone back together, and since this system is less traumatic to the surrounding muscles, it offers a quicker recovery and may restore more function than typically gained with other methods.

About 5 percent of all fractures are shoulder joint fractures. They can occur in traumatic accidents, but they usually happen as a result of a fall. Falling on the shoulder can break off the ball part of the humerus, or upper arm bone, which fits into the shoulder socket. You usually end up with three or four pieces that are displaced by the pull of the tendons and the muscles, and you have to put the puzzle back together for it to heal, says Dr. Augustine. This requires anything from pins and sutures to this new device, called a shoulder nail plate.

Inventing a Better Wheel
Traditional repair methods are plagued by potential problems. Nothing really seemed to be the answer, Dr. Augustine says. Just moving the shoulder can cause pins used to hold the pieces of bone together to dislocate and become infected. Sometimes the joint doesn't heal well, and fixation with external pins can be so painful that patients can't move the joint for four-to-six weeks. The shoulder joint permits the widest range of movement than any other joint in the body and falls and motorcycle accidents are the two major causes of this type of fracture.

This X-ray shows the ball of the humerus completely broken off....Ouch!

Using the new shoulder nail plate system, Dr. Augustine makes an incision about three inches long on the side of the patient's shoulder to separate the muscles and expose the broken humerus. Then he inserts the stem of the shoulder nail plate device into the shaft of the humerus. In a process much like trying to put a scoop of ice cream back on top of the cone, he uses guides in a special, external jig and temporary wires to draw the ball back on top of the bone and then fix it in place with locking pegs driven through precisely angled holes in the plate so the pegs would spread evenly throughout the ball. He sutures fragments of the ball back in place, securing them through additional holes in the plate. Then he makes a smaller incision below the first one in order to permanently screw the device in place.

With the shoulder nail plate, patients start using their arm and elbow the day after surgery, Dr. Augustine says. Stiffness is a big problem for people who sustain this type of fracture. So hopefully by getting a strong, stable construct right away, and by getting patients moving right away, we will be able to combat that and make it less of a problem.

That's it from Dr. Augustine for now. If you want to learn more about this type of surgery or have any questions regarding MX related injuries, either go to or check out the Jacksonville Orthopedic Institute site at

That's it for now, until next time, good luck with your training and remember, if you have a question, log on to the Virtual Trainer Expert Forum and have your question answered by a panel of experts. In addition, be sure and check out the Racer X Virtual Trainer archive section. Your complete one-stop information zone for motocross fitness. VT Signature

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  1. Gravatar
    WAAAAAHA PRIDE November 10, 2011 at 7:02 pm


  2. Gravatar
    Rachel Liljeberg January 25, 2012 at 12:52 pm

    I just read your article about broken daughter was racing her dirtbike at Hangtown and fell and broke the ball off of the humerus bone and has a plate and seven screws in her arm very similar to the picture on your website.

  3. Gravatar
    Racer X Virtual Trainer January 25, 2012 at 2:10 pm

    Ouch!!!! Hope she recovers and is back on her dirtbike soon!

  4. Gravatar
    Loud a Mullins May 02, 2012 at 12:13 pm

    I to broke my humerus about 4 weeks ago had surgery it looks like that I start rehab Friday I got the plate and 13 screws doctor said no riding ever I was bummed out sold my bike 4 weeks later he said I could ride just give it 6 months to a year

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