Clavicle fracture and its management

Clavicle fracture and its management by Dr Bipul Borthakur

1. CLAVICLE FRACTURE AND ITS MANAGEMENT DR. BIPUL BORTHAKUR PROFESSOR, DEPT. OF ORTHOPAEDICS SMCH

2. CLAVICLE OSTEOLOGY

3. LIGAMENTS

4. PECULARITIES OF CLAVICLE Synonyms – collar bone; beauty bone . Most superficial bone and first bone to ossify and last to fuse. Only long bone which lies horizontal in the body . It is occasionally pierced by the middle supra-clavicular nerve .

5. FUNCTION OF CLAVICLE Serves as bony link between Axial and Upperlimb Stable linkage for shoulder movements and contributes significantly to power and stability of shoulder girdle. Protective cover to vital neurovascular structures like Brachial plexus Also contributes to respiratory movements.

6. MECHANISM OF INJURY

7. DEFORMING FORCES

8. CLASSIFICATION

9. ALLMAN CLASSIFICATION OF CLAVICLE FRACTURE

10. 1.AP VIEW

11. ASSOCIATED INJURIES Vascular injuries require repairing . Neurological injuries Possible thoracic injury.

12. TREATMENT

13. NON OPERATIVE MANAGEMENT In children , the fracture is un-displaced and hence a cuff and collar sling . In adults , - Figure of 8 (Bracing back) - Triangular sling or Armsling

14. Contd … If the fracture fragments are displaced, the distal fragment is lifted upwards and pulled backwards and figure of 8 bandage is applied with cotton padding of both axilla. Periodic checkups are important to look for pressure sores in the axillary folds by figure of 8 bandage. In elderly , the displacements are ignored and treated with triangular sling for 3-4 weeks and followed by active exercise of the shoulder.

15. OPERATIVE TREATMENT Indications: Open fractures. Comminuted displaced fractures with tenting of skin. Neurovascular injuries. Symptomatic non-union. Soft tissue interposition. Clavicle fracture with associated glenoid or scapular neck fracture. Fracture of distal third with ligament rupture. Polytraumatized patient.

16. Intramedullary fixation with a headed, distally threaded pin( modified haigie pin). A . retrograde drilling of distal fragment. B . Reduction and fixation of fracture. C . Addition of bone graft or bone graft substitute.

17. Anatomical plates

18. HOOK PLATE FIXATION OF DISPLACED FRACTURE OF LATERAL END CLAVICLE

19. EXTRAMEDULLARY PLATE FIXATOR

20. COMPLICATION Malunion (most common). Infection. Nonunion (rare). Neurovascular injury. Acute injury (scapulothoracic dislocations).

21. TODAY’S QUESTION ; Which part of clavicle fractures commonly? kindly message on Mob : [phone] Email : [email protected] [email protected]