Clavicle injury · Web viewfracture, lung injury, shoulder girdle) Management: BAS and early...
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Transcript of Clavicle injury · Web viewfracture, lung injury, shoulder girdle) Management: BAS and early...
Clavicle Injury
Clavicle Fracture
I + III: conservatively with BAS (figure of 8 bandage if large amount displacement to prevent anterior drift of scapula); for 3-4/52 in young children, 4-6/52 in older children, 6-8/52 in adults; limit activity for next 8/52Indications for OT: Open fracture middle 1/3, severe angulation or complete displacement of mid-shaft, NVI, displaced type II, comminuted, elderly female with osteoporosis, disruption of ligaments in distal 1/3OT associated with greater patient satisfaction, pain, non-union rate, better function, quicker return to work
NeerClassification
I
II
III
Lateral to coracoclavicular ligament; non-displaced
Disruption of conoid + trapezoid ligaments; upward displacement of proximal fragment; unstable
Intra-articular
Manage-ment
Sterno-clavicular Joint Dislocation
Anterior dislocation most common; magnified clavicular head on plain film compared to other; usually managed closedPosterior dislocation potentially serious (brachiocephalic and subclavian venous obstruction, tracheal compression, neurological injury, subclavian, brachiocephalic and carotid artery compression) and requires OT
Sterno-clavicular Joint
Dislocation(cntd)
Acromio-clavicular Joint
Dislocation I
II
III
AC ligament partially torn; no subluxation; normal XR; = sprain
AC ligament torn; CC ligament sprain; subluxation <1cm; normal CC joint space
AC and CC ligaments torn; disrupted joint capsule, deltoid and trapezius muslces; on XR >1cm sublucation and >50% widening of CC joint space
IV
V
VI
As III, but posterior displacement of clavicle
Widely superior displacement
Inferior displacement
MOI: fall on point of shoulderManagement: 1-2/52 BAS (4-6/52 if dislocation); IV, V and VI may need OT
Fractured clavicleAND
Fractured humerus / glenoid
Floating Shoulder
Usually body; often severe trauma; most commonly in young adult men; 50-75% associated with thoracic injury (eg. Rib fracture, lung injury, shoulder girdle)Management: BAS and early mobilisation if blade only; OT if displaced articular fracture of glenoid, angulated glenoid neck fracture, acromial fracture with rotator cuff tear, some coracoid fractures
Scapula Fracture