CLAVICLE FRACTURE clinical features and management

Clavicle fracture

1. CLAVICLE FRACTURES

2. CLASSIFICATION ALLMAN CLASSIFICATION- Group I fractures(middle 1/3 rd ) -most common Group II fractures(distal 1/3 rd ) -less common Group III fractures(medial 1/3 rd ) -less than 5%

3. NEER CLASSIFICATION- distal clavicle fractures divided into three subgroups, based on their ligamentous attachments and degree of displacement Type I: Distal clavicle fracture with the coracoclavicular ligaments intact Type II: Coracoclavicular ligaments detached from the medial fragment, with the trapezoidal ligament attached to the distal fragment Type III: Distal clavicle fracture with extension into the AC joint.

4. AO/OTA CLASSIFICATION- divided into medial metaphyseal, diaphyseal, and lateral metaphyseal fractures

5. TREATMENT NON-OPERATIVE – I ndications < 2cm shortening and displacement closed and no neurovascular injury M odalities- sling figure-of-8 brace Immobilization for 2-6 weeks.

6. OPERATIVE- MIDSHAFT FRACTURES : INDICATIONS- Fracture-Specific : Displacement >2 cm Shortening >2 cm Increasing comminution (>3 fragments) Segmental fractures Open fractures Impending open fractures with soft tissue compromise

7. Associated Injuries- Vascular injury requiring repair Progressive neurologic deficit Ipsilateral upper extremity injuries/fractures Multiple ipsilateral upper rib fractures Floating shoulder Bilateral clavicle fractures Patient Factors Polytrauma with requirement for early upper extremity weight-bearing/arm use Patient motivation for rapid return of function

8. MIDSHAFT CLAVICLE FRACTURE OPERATIVE PRICEDURES: EXTERNAL FIXATION INTRAMEDULLARY PINNING OPEN REDUCTION AND PLATE FIXATION

9. EXTERNAL FIXATION- Thi s method takes advantage of the intrinsic healing ability of the clavicle and allows restoration of length and translation without the scarring or morbidity of a surgical approach there is no retained hardware at the conclusion of treatment the practical difficulties associated with the position and prominence of the fixation pins, resulted in minimal use of the technique.

10. HOOK PLATE- Placed sub acromially selected when there is insufficient purchase of distal fragment AC joint identified, posterior edge of clavicle dissected free, enter into joint posteriorly with large curved scissors which create place for hook space should be made posteriorly. Once this path has been created, the hook is placed in it and the plate reduced to the shaft of the clavicle

11. P OSTOP CARE Arm is placed in sling and gentle pendulum exercises can be initiated. Suture removal can be done on 10 th post op day At 2 weeks follow up sling can be discontinued and unrestricted range of movements are allowed but no strengthening exercises At 6 weeks postoperatively, radiographs are taken to ensure bony union. If they are acceptable, the patient is allowed to begin resisted and strengthening activities After 12 weeks aggressive activities like sports can be permitted .

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