Case: shoulder injury following the bike accident

A 39-year old man is brought to the emergency department for evaluation of a shoulder injury sustained as the result of a fall from his road bike. He denies the loss of his consciousness, headache, neck or back pain, or other injury, and he reports that he was wearing a helmet. The triage nurse comments that the shoulder looks dislocated and asks if procedural sedation is needed for him.

The patient’s vital signs are normal. General physical examination is normal except for an abrasion on the top of the shoulder with visible deformity, tenderness and guarding of the shoulder with limited range of motion. His distal neurovascular examination is intact.

Initial diagnostic concerns include a clavicle fracture, humeral fracture, shoulder dislocation, scapular fracture and acromioclavicular (AC) joint separation.

What does the radiography show?
What is the next best step for treatment?

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