Fracture of the clavical clinical 2.pptx

Fructure of clavicle

1. Fracture of the clavical

2. CLAVICLE : Is an S-shape long,curved,tubular bone, lies horizontally a cross the root of neck It articulate with sternum medially to form sternoclavicular joint. Also articulate with acromion process of scapula at acromioclavicular joint and acromioclavicular ligament T he muscles inserting on clavicle are: sternocleidomastoid , And subclavius muscles The subclavian vessels and brachial plexus lie posterior to clavicle

3. Functions of Clavicle It increases the arm strength mechanism. It protects the neurovascular bundle consisting of subclavian vessels and brachial plexus. It gives attachments to important muscles around the shoulder. It braces the shoulder back during rest and motion (Strut function).

4. ncidence : • The commonest fracture in the body. • Usually affect the middle 1/3 of the clavicle (80%) due to : 1. The thinnest part of the bone. 2. It is the junction between 2 curves 3. It is the site of change in the contour of bone. 4. The groove of the subclavius & foramen caused by the large nutrient artery

5. Pathology I) Classification : • According to site : ▪ Fracture middle 1/3 (80%) ▪ Fracture lateral 1/3 (15%) ▪ Fracture medial 1/3 (5%) II ) Displacement : • Medial fragment → pulled upwards & backwards by the sternomastoid . • Lateral fragment → displaced downwards (by the weight of the limb), forwards and medially (by pectoralis major)

6. Clinical Features The patient presents with : pain & swelling deformity inability to raise the shoulder Rarely, the patient may present with pseudo-paralysis of the affected arm.

7. Complications: ( no general complications ) 1- Malunion , deformity & excessive callus formation are the commonest complications but function of the upper limb is not affected . 2- Injury of subclavian vessels, brachial plexus and dome of pleura. [Type text] 3- Non union 1- Stiffness of shoulder joint specially in elderly , if mobilization is not resumed rapidly after union of the fracture .

8. Diagnosis The following views are recommended: Clinical picture \ examination. investigation : x-ray [AP view]: is usually in middle third, > outer fragment below of the inner . Distal clavicle requires special radiography
technique. CT scan: useful for non union assessment. A rteriography : if vascular injury suspected

9. treatment I. Conservative treatment is the usual treatment by using a broad arm sling or figure 8 clavicle brace only , without reduction , combined with analgesics for 3 weeks. I) Open reduction & internal fixation : • Indications : rarely needed in case of one of the followings ▪ Vascular, nervous or pleural injury. ▪ Cosmetic reasons in females. ▪ Painful non-union. • Method : usually by plate and screws . 3. Rehabilitation: Active movement of the fingers since the first day

10. Treatment Plan according to age Newborn to perambulatory children: Treated symptomatically, bind arm to the chest. Ambulatory stage (2-12 yr): Figure of ‘8’ bandages, tightened after three days and later one week. Twelve years to maturity (above 12yr) : Commercially available figure of ‘8’ harness.

11. FRACTURE OF THE SCAPULA

12. Scapula Scapula : Is a flat triangular bone that lies on the posterior thorax wall between 2-7 rib. It envelope by: supraspinatus muscle infraspinatus muscle subscapularis muscle Attached to clavicle at acromioclavicular joint,secured by acromioclavicular ligament. Articulate with humerus at glenohumeral joint... Attached to thorax in scapulothoraxic joint.

13. Incidence It is a rare injury. • 3 to 5 % of all shoulder girdle injuries. • 0.4 to 1 % of all fractures. • Mean age is 35 to 45 years. FRACTURE OF THE SCAPULA

14. Functions of scapula • Stabilizes the upper extremity against the thorax. • Links the upper extremity to the glenoid. Mechanism of Injury s • Direct blow—fall of a heavy object on the shoulder blade . Common causes include direct blunt trauma , crushing injuries , falls and seizures . • Axial loading on the outstretched hands. There associated injuries such as rib fractures and other intra-thoracic injuries are common.

15. Mechanism of injury : Injury of body : from sever direct trauma - fall from height with direct landing on posterior aspect of trunk. - motor vehicle crush of neck : direct blow to shoulder - fall shoulder - fall on outstretched hand of glenoid : direct blow to lateral aspect of shoulder or impaction of humeral head in to glenoid fossa, may dislocation of the shoulder Of coracoid process :direct blow or shoulder dislocation of acromion : direct down ward blow to shoulder.

16. Classification (Thompson’s) Type I: Coracoid, acromion and small fractures of the body. Type II: The glenoid and neck fractures. Type III: Body fractures major Note: • Neck fractures —10 to 60 % • Body fractures—49 to 89 % • Glenoid fractures—9 %

17. Fractures of the scapular body Fractures of the glenoid neck Intra-articular glenoid fossa fractures (Ideberg modified by Goss) • Type I Fractures of the glenoid rim • Type II Fractures through the glenoid fossa, inferior fragment displaced with subluxed humeral head • Type III Oblique fracture through glenoid exiting superiorly (may be associated with acromioclavicular dislocation or fracture) • Type IV Horizontal fracture exiting through the medial border of the scapula • Type V Combination of type IV and a fracture separating the inferior half of the glenoid • Type VI Severe comminution of the glenoid surface

18. Fractures of the acromion • Type I Minimally displaced • Type II Displaced but not reducing subacromial space • Type III Inferior displacement and reduced subacromial space Fractures of the coracoid process • Type I Proximal to attachment of the coracoclavicular ligaments and usually associated with acromioclavicular separation • Type II Distal to the coracoacromial ligaments

19. Clinical Features The patient complains of : pain and swelling , Severe bruising over the scapula or the chest wall. arm is held adducted to the sides of the chest , all movements of the shoulder, especially abductions,are painful , may be associated rarely with pneumothorax and inability to elevate the arms may give a feeling of pseudo-rupture of the rotator cuff.

20. Radiographs Scapular fractures can be difficult to define on plain X-rays because of the surrounding soft tissues. A true scapular AP view and a true lateral view (axillary view) helps to make the diagnosis. CT and 3D reconstruction are useful for demonstrating glenoid fractures or body fractures

21. complication Complications : 1-Osteoarthrosis & stiffness of shoulder joint if articular surface is affected . 2-Associated chest injury is common Treatment : 1- Usually conservative treatment by broad arm sling . [Type text] 2- Open reduction & internal fixation is occasionally needed , by screws or plate & screws , for displaced intra-articular fracture affecting the glenoid cavity