Clavicle Injury

Clavicle Fracture

I + III: conservatively with BAS (figure of 8 bandage if large amount displacement to prevent anterior drift of scapula); for 3-4/52 in young children, 4-6/52 in older children, 6-8/52 in adults; limit activity for next 8/52Indications for OT: Open fracture middle 1/3, severe angulation or complete displacement of mid-shaft, NVI, displaced type II, comminuted, elderly female with osteoporosis, disruption of ligaments in distal 1/3OT associated with greater patient satisfaction, pain, non-union rate, better function, quicker return to work

NeerClassification

I

II

III

Lateral to coracoclavicular ligament; non-displaced

Disruption of conoid + trapezoid ligaments; upward displacement of proximal fragment; unstable

Intra-articular

Manage-ment

Sterno-clavicular Joint Dislocation

Anterior dislocation most common; magnified clavicular head on plain film compared to other; usually managed closedPosterior dislocation potentially serious (brachiocephalic and subclavian venous obstruction, tracheal compression, neurological injury, subclavian, brachiocephalic and carotid artery compression) and requires OT

Sterno-clavicular Joint

Dislocation(cntd)

Acromio-clavicular Joint

Dislocation I

II

III

AC ligament partially torn; no subluxation; normal XR; = sprain

AC ligament torn; CC ligament sprain; subluxation <1cm; normal CC joint space

AC and CC ligaments torn; disrupted joint capsule, deltoid and trapezius muslces; on XR >1cm sublucation and >50% widening of CC joint space

IV

V

VI

As III, but posterior displacement of clavicle

Widely superior displacement

Inferior displacement

MOI: fall on point of shoulderManagement: 1-2/52 BAS (4-6/52 if dislocation); IV, V and VI may need OT

Fractured clavicleAND

Fractured humerus / glenoid

Floating Shoulder

Usually body; often severe trauma; most commonly in young adult men; 50-75% associated with thoracic injury (eg. Rib fracture, lung injury, shoulder girdle)Management: BAS and early mobilisation if blade only; OT if displaced articular fracture of glenoid, angulated glenoid neck fracture, acromial fracture with rotator cuff tear, some coracoid fractures

Scapula Fracture