Dr Naveed clavicle fracture classification

clavicle fractures

1. DR. MD NAVEED ASSISTANT PROFESSOR ORTHOPAEDICS KAMSRC

2. ANATOMY First bone to ossify ( 5 th week of gestation Last bone to fuse ( Sternal end )- 22 to 25 yrs of age S-shape long, curved ,tubular bone , lies horizontally across the root of neck . Medial end -widest convex forward lateral end – thin concave forward Clavicle – Part of pectoral girdle

3. ANATOMY Clavicle functions as a strut, bracing the shoulder from the trunk Allowing the shoulder to function at optimal strength Medial third clavicle protects brachial plexus , subclavian and axillary vessels and superior lung.

4. ANATOMY Distal clavicle contains the coracoclavicular ligaments Trapezoid and Conoid ligaments Provide vertical stability Stronger than Acromioclavicular ligaments

5. C lavicle Fracture C ommon fracture in all ages especially in children . 2 .6% of all fractures and about 50% fractures about the shoulder . Most common fracture in children.

6. MECHANISM OF INJURY Fall onto the affected shoulder- 87 % Direct impact - 7% Fall on outstretched hand – 6%

7. MOST COMMON CAUSES Road trafficaccident [RTA] Sport s injuries

8. RARE CAUSES Secondary to muscle contractions during seizures Stress fractures Secondary to minimal trauma to pathologic bone

9. Why does the fracture occur in middle third more ? It is the thinnest part of the bone . It is the junction of the t wo main curves of shaft . Site of entrance of nutrient artery .

10. Clinical Presentation S welling Obvious deformity . Patient come s by support ing his injured limb with other hand and head tilted toward injured side. Local bruising /Skin tenting Tenderness crepitus

11. V ascular compilication are rare , but we must look for it by : check pulse , gently palpate root of neck Outer third # are easily missed for acromioclavicular joint injuries .

12. ASSOCIATED INJURIES Rib Fractures – 9% cases (most common association ) Brachial plexus traction injury – seen with proximal third clavicle fractures Skin abrasion – over the clavicle

13. DIAGNOSIS - Clinical picture E xamination I n v e s tigatio n s x-ray[AP view ] : # is usually in middle third, outer fragment below the inner . # of outer third may be missed . CT scan : useful for non union

14. C ommon pattern of fractures Green stick fra c tu r e : Unicortical fracture Common at the between middle and outer third junction. Common in children .

15. Un displaced fracture

16. Displaced fracture

17. Fracture w ith greater displacement and overlapping •

18. TREATMENT T h e aim is to provide support for the weight of the arm . F r a : c t ur e of clavicle unite with or without treatment . Healing occurs usually in 3- 6 weeks . C onservative or surgical .

19. CONSERVATIVE TREATMENT Support the arm in a sling until the pain subsides , us ually for 1- 3 weeks . Figure of 8- bandage . Clavic le brace Arm sling pouch

20. ARM SLING POUCH

21. SURGICAL TREATMENT Open reduction and internal fixation (ORIF )- with Plates and Screws. Over superior or antero inferior surface of clavicle INDICATIONS L ateral one third fracture Middle third fracture with 100% displacement / > 2cm Shortening / comminution Open fractures Closed fractures with skin tenting P resence of neurovascular injury . N on union cases .

22. REHABILITATION P atient should be instructed regarding hand wrist and elbow exercises during immobilization . And regarding shoulder exercises once fracture healed .

23. COMPLICATIONS Neurovascular injury [rare] – Subclavian vessels (Traumatic or Iatrogenic ) Malunion – cause bony prominence due to Deformity and Shortening

24. COMPLICATIONS Non union : Incidence is 0.1 to 13 % with maximum non unions occuring at middle third clavicle fractures. Risk Factore include- Open fractures Displaced fracture Soft tissue interposition Inadequate period of immobilization. Treated by internal fixation and bone grafting .

25. COMPLICATIONS Posttraumatic Arthritis Stiffness of shoulder – Intra articular Fractures involving AC JOINT OR SC joint.