Clavicle fractures (Fraktur Pada Clavicula)

fraktur clavicula

1. CLAVICLE FRACTURES

2. Epidemiology Clavicle fractures are common injuries in young, active individuals Approximately 2.6% of all fractures and for 44% to 66% of fractures about the shoulder Middle third fractures : 80%-85% of all clavicle fractures Lateral fractures : 15% Medial third fractures : 5%

3. Anatomy

4. Mechanism of Injury A direct blow on the point of the shoulder is the commonest reported mechanism of injury. Falls onto the affected shoulder leading to a bending force account for most (87%) of clavicular fractures, direct impact accounting for 7% and falls onto an outstretched hand accounting for 6%. As the shoulder girdle is subjected to compression force directed from laterally, the main strut maintaining position is the clavicle and its articulations.

5. Clinical Evaluation History  the details of the mechanism of injury Patients usually present with splinting of the affected extremity, with the arm adducted across the chest and supported by the contralateral hand to unload the injured shoulder The proximal fracture end is usually prominent and may tent the skin. Assessment of skin integrity is essential to rule out open fracture Shortening of the clavicle should be measured clinically Careful neurovascular examination Chest examination

6. Associated Injuries Up to 9% of patients with clavicle fractures have additional fractures, most commonly rib fractures. Most brachial plexus injuries are associated with proximal third clavicle fractures (traction injury). The skin is often abraded as a result of the injury mechanism. Patients with clavicle fractures, and have noted a high mortality rate (20% to 34%) from associated chest and head traumas.

7. Radiographic Evaluation Standard anteroposterior (AP) thorax radiographs A chest x-ray allows for side-to-side comparison, including normal length A 30-degree cephalad tilt view ( serendipity views) AP thorax with weight bearing (Stress view)

8. Classification

9. Classification AO/OTA classification

10. Acromioclavicular joint injury Classified depending on the degree and direction of displacement of the distal clavicle

11. Treatment

12. NonOperative The 30th century BC. Hippocrates described the typical deformity resulting from this injury, and emphasized the importance of trying to correct it. Most minimally displaced clavicle fractures can be successfully treated nonoperatively with some form of immobilization figure-of-eight bandage / simple sling Comfort and pain relief are the main goals In general, immobilization is used for 4 to 6 weeks. During the period of immobilization, active range of motion of the elbow, wrist, and hand should be performed.

13. Operative External Fixation Intramedullary Pinning Open Reduction and Plate Fixation

14. Complications Neurovascular compromise: This is uncommon and can result from either the initial injury or secondary to compression of adjacent structures by callus and/or residual deformity. Subclavian vessels are at risk with superior plating. Malunion: This may cause a bony prominence Nonunion: The incidence of nonunion following clavicle fractures ranges from 0.1% to 13.0% Posttraumatic arthritis: This may occur after intra-articular injuries to the sternoclavicular or AC joint

15. TERIMAKASIH