Clavicle Fracture cause management and treatment.pptx

Clavicle fracture management

1. Clavicle Fracture Dr Robin Yadav MBBS(BPKIHS),MS(AIIMS) LECTURER NMCTH

2. Osteology Shape S-shaped bone flat laterally, tubular centrally, and prismatic medially  Articulations  sternoclavicular joint -four primary stabilizers 1.posterior capsular ligament 2.anterior sternoclavicular ligament 3.costoclavicular ligament 4.intra-articular disc

3. acromioclavicular joint two primary stabilizers 1.coracoclavicular ligament  2.acromioclavicular ligament  Muscles sternocleidomastoid -pulls medial segment proximally

4. pectoralis major pulls medially causing shortening  clavicular head originates from anteroinferior surface of medial half of clavicle inserts on crest of greater tubercle of humerus , lateral to bicipital groove

5. Ligaments coracoclavicular (CC) ligaments provide superior/inferior stability to AC joint two components  trapezoid (lateral)  conoid (medial) 

6. Blood Supply subclavian vessel passes posterior and underneath clavicle near junction of medial and middle third subclavian vein closest to clavicle and anterior to artery and plexus Nervous System supraclavicular nerves cutaneous nerves that run vertically over clavicle and supply superior chest wall

7. Biomechanics middle third is weakest portion of clavicle  thinnest and narrowest transitional of the bone in both curvature and in cross-sectional anatomy only area not supported by ligamentous or muscular attachments

8. Epidemiology Incidence common incidence 1 in 1000 people per year P revalence   clavicle fractures account for 2.6-4% of all adult fractures Demographics often seen in young, active patients most common in males < 30 years old Location 75-80% of all clavicle fractures will occur in the middle third segment

9. Etiology Pathophysiology mechanism of injury fall onto lateral aspect of shoulder (85%) direct impact to clavicle  Pathoanatomy junction of the outer and middle third is the thinnest part of the bone prone to fracture with axial loading only area not protected by or reinforced with muscle and ligamentous attachments

10. D isplaced fractures medial fragment pulled  posterosuperiorly by sternocleidomastoid muscle  lateral fragment pulled  inferomedially by pectoralis major and and weight of arm  open fractures usually result from medial fragment "buttonholing" through platysma

11. Associated conditions Associated conditions Medical   pneumothorax closed head injury  orthopedic ipsilateral scapular fracture (floating shoulder) scapulothoracic dissociation   rib fracture   neurovascular injury

12. Classification

13. Presentation History popping or cracking sound near shoulder after fall Symptoms acute onset of anterior shoulder pain or directly over clavicle Physical exam inspection tender, swelling, crepitus and deformity over clavicle skin tenting (impending open fracture)  neurovascular exam assess subclavian vessels and brachial plexus

14. Imaging Radiographs Clavicle series upright AP clavicle 15° cephalic tilt ( zanca view)  shoulder series evaluate for other injuries ( ie proximal humerus , scapula)

15. Treatment Nonoperative sling immobilization Indications < 2cm shortening and displacement   closed and no neurovascular injury low demand patient  techniques sling figure-of-8 strap

16. Operative  open reduction internal fixation (ORIF) indications   absolute open fractures displaced fracture with skin tenting  subclavian artery or vein injury floating shoulder (clavicle and scapular neck fracture)

17. intramedullary fixation open reduction internal fixation with plate and screws

18. Complications Nonunion Malunion hardware prominence supraclavicular nerve injury  Infection mechanical failure (~1.4%) pneumothorax adhesive capsulitis

19. Thank you