clavicle fractures
TRANSCRIPT
Clavicle Fractures
Case Review #3
The Clavicle
•A long, curved bone that sits nearly horizontal•Forms the anterior portion of the shoulder girdle•Bony connection between the upper limb and thorax•Lateral motion of the arms
Functions of the ClavicleRigid support for scapula
and armProtection for NV bundle
and lung apexMotion and stabilityTransmission of physical
impactsMuscle attachments
Clavicle FracturesMost common acute shoulder injuryMost common fracture in children and young adultsEasily fractured
Classification Systems: Allman and Neer
Allman Classification
Neer ClassificationGroup 2 Type 1 •Intact ligaments
Group 2 Type 2•Conoid and Trapezoid ligaments are intact•Proximal segment is displaced
Group 2 Type 2B•Conoid ligament is ruptured•Trapezoid ligament remains intact•Proximal segment is displaced
How do clavicle fractures happen?
Direct fall onto shoulderContact sportsFOOSH – in a small % of casesMVAChild birth
When the clavicle fractures.....
Elevation of the medial fragment
Drooping of the arm
Unable to sustain the weight of the
arm
The Patient.....An 8 yr old maleFell into a ditch
May 1, 2013Mild displacement of the distal 1/3 right clavicle fracture
June 13, 2013Follow up visit to the Ortho ClinicHealing fracture of the lateral 1/3 with mild deformity & displacement
PACS Image 478 0856.001K
Patient Care Concerns....
Patient may be on a stretcher.....Pain, bleeding, swelling, bruising, tenting.....Immobilized.....Scared.....Vital Signs.....ABC’s
Treatment Plans and Follow up.......
Diagnostic Imaging......
Views of the Clavicle:APAP Axial (15-30 degree cephalic)
If Pneumothorax or Hemothorax is suspected......
Non-operative Treatments.....Immobilization (sling, figure 8 bracing).....
Non-operative Treatments cont’d....
Physiotherapy
Pendulum ExercisesBall Grip
One should avoid:•Arm raising•Lifting more than 5 lbs
•Use ice to reduce pain, swelling and inflammation•Good body mechanics•immobilization
Non-operative Treatments con’t....
Follow up visits with doctor/orthopedic surgeonSubsequent imaging to check for healing progressPain management
Surgery may be warranted if......
Comminuted fractures Clavicle foreshorteningOpen fractureNeurovascular involvementNon-union of boneInterference with normal functioning
Operative Techniques
Plate Fixation Intramedullary Fixation
Some interesting facts.......
Did you know.....The clavicle is reliable in determining gender differences........
In the male:•Longer and thicker•Acromial end is slightly higher than the sternal end
In the female:•Thinner an shorter•Smoother and lighter•Acromial end is slightly below level of sternal end
The clavicle can also be useful for.....
Bone Age Assessment
Distal Clavicular OsteolysisOveruse injuryConsistent with stress fracturesCommon with weightliftersTrauma can precipitate developmentJoint space enlargement
Thoracic Outlet Syndrome
Common causes:TraumaCallus formationRepetitive injuryInjury from years agoAnatomical defects
Blood vessels and nerves become compressed causing pain and numbness
Medial clavicle fractures can be very dangerous....
•A 19 yr old male on a motorbike involved in a head on collision
•Chest x-ray revealed a massive left Pneumo-hemothorax and mediastinal shift
•Neurovascular damage
Fracture of the medial 1/3 clavicle with significant displacement
References.....•Clavicle fracture. (2013, July 16). Retrieved from http://www.patient.co.uk/doctor/Fractured- Clavicle.htm •Clavicle fracture classification. (2013, July 16). Retrieved from http://eorif.com/clavicle-fracture-classification •Daruwalla, Z., Courtis, P., Fitzpatrick, C., Fitzpatrick, D., & Mullett, H. (2010). An application of principle component analysis to the clavicle and clavicle fixation devices. Retrieved from http://openi.nlm.nih.gov/detailedresult.php?img=3003245_1749-799X-5-21-11&req=4 •Distal clavicular osteolysis. (2010). Retrieved from http://www.wosm.com/index.php/orthopaedic-services-/shoulder/141-distal-clavicular-osteolysis •Faisham, W. I., Mohammad, P., Juhara, H., Munirah, N. M., Shansulkamaruljan, H., & Ziyadi, G. M. (2011, June). Clavicle fracture and subclavian vessels disruption with massive haemothorax mimic intrathoracic injury. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216210/ •Rubino, MD, L. J. (2012, March 7). Clavicle fractures. Retrieved from http://emedicine.medscape.com/article/1260953-overview •Thoracic outlet syndrome. (2013, July 16). Retrieved from http://www.mayoclinic.com/health/thoracic-outlet-syndrome/DS00800/DSECTION=causes