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    Clavicle #

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    Haidi Syuhairi
    This document discusses clavicle fractures, including: 1. The anatomy and development of the clavicle bone. 2. Classification of clavicle fractures into three main groups based on location. 3. Treatment options that depend on fracture location and severity, including nonsurgical immobilization or surgical fixation using plates or pins.

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    Clavicle #

    Uploaded by

    Haidi Syuhairi
    111 views41 pages
    This document discusses clavicle fractures, including: 1. The anatomy and development of the clavicle bone. 2. Classification of clavicle fractures into three main groups based on location. 3. Treatment options that depend on fracture location and severity, including nonsurgical immobilization or surgical fixation using plates or pins.

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    This document discusses clavicle fractures, including: 1. The anatomy and development of the clavicle bone. 2. Classification of clavicle fractures into three main groups based on location. 3. Treatment options that depend on fracture location and severity, including nonsurgical immobilization or surgical fixation using plates or pins.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    111 views41 pages

    Clavicle #

    Uploaded by

    Haidi Syuhairi
    This document discusses clavicle fractures, including: 1. The anatomy and development of the clavicle bone. 2. Classification of clavicle fractures into three main groups based on location. 3. Treatment options that depend on fracture location and severity, including nonsurgical immobilization or surgical fixation using plates or pins.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 41

    CLAVICLE FRACTURE

    PRESENTATOR:DR MOHD HAIDI SYUHAIRI BIN HANAFI SUPERVISOR:MISS (DR) ISNONI ISMAIL

    Department of Orthopaedic Surgery and Rehabilitation

    OVERVIEW
    Anatomy Ossification Functions Classification Signs and Symptoms Physical Examination Treatment Rehabilitation

    ANATOMY

    OSSIFICATION
    1st bone to ossify and last bone to finish ossification. from 3 centers :

    - 2 primary centers, medial and lateral5th or 6th week intrauterine life - secondary center(sternal end)18th or 20th year, unites25th year

    VARIATIONS

    - thicker and more curved in manual workers, sites of muscular attachments more marked. - right clavicle stronger and shorter. - In femalesshorter, lighter, thinner, smoother and less curved. -femaleslateral end little below medial end; -malessame level or slightly higher than the medial end

    FUNCTIONS
    Acts as a strut to keep the scapula in positionarm can hang freely Cover cervicoaxillary canalprotects neurovascular bundle Transmits physical impacts from upper limb to axial skeleton.

    may be congenitally absent or imperfectly developedcleidocranial dysostosis +shoulders droop +can be approximated anteriorly in front chest.

    Clavicle Fractures

    Mechanism
    Fall onto shoulder (87%) Direct blow (7%) Fall onto outstretched hand (6%)

    The clavicle is the last ossification center to complete (sternal end) at about 22-25yo.

    Trimodal distribution
    80 70 60 50 40 30 20 10 0 Group I (13yrs) Group 2 (47yrs) Group 3 (59yrs) Percent

    Classification
    A.Group 1 Middle Third (80%)

    B.Group 2 Distal Third (15%) Type 1:lateral to cc ligament Type 2a:medial to cc ligament Type 2b:between cc ligament(conoid torn,trapezoid intact) Type 3:# into ACJ C.Group 3 ProximalThird (5%)

    Complaints
    Pain Swelling Possible nausea, dizziness, spotty visiondue to extreme pain

    Physical examination

    Attitude-arm held close to body,supported by hand Tenderness Deformity Swelling Crepitus

    Ecchymosis Bleedingopen fracture (rare) Decreased breath soundsindicating possible pneumothorax Decreased pulsessuggesting vascular compromise Diminished sensation or weaknesssuggesting neurologic compromise Nonuse of the arm on the affected side

    Diagnostic
    XrayAP view CT scan maybe required

    Middle

    rd 3

    Distal

    rd 3

    Proximal

    rd 3

    Other test
    Chest radiographyif pneumothorax suspected Angiographyif vascular injury suspected

    Treatment

    Medial and Middle fractureusually nonoperative

    1.Ice 2.Analgesic 3.Sling immobilizationfor3-4 weeks with early ROM


    1.
    2. 3.

    Distal fracture
    Much controversy exists regarding the appropriate management. Current recommendationsfix surgically Neer found that although distal third clavicle fractures are rare, they account for approximately half of all clavicular nonunions.

    Surgical indications
    1. 2. 3. 4. 5. 6. Fractures with neurovascular injury Fractures with severe associated chest injuries Open fractures Group II, type II fractures Cosmetic reasons, uncontrolled deformity Nonunion

    Surgical choice
    OR+plate fixation OR+pin insertion

    Advantages of plate fixation


    1.

    2.
    3. 4.

    Easily available Commonly used Standard technique Direct osteon healing

    Complication of plate fixation


    Painful, prominent hardware Soft tissue stripping Non-cosmetic scar Multiple stress risers Permanent if 33% of clavicle diameter Nerve damage Infection

    Infection after plate fixation


    Reports range from 0.4% - 7.8% Bostman: 7.8% Liu, et al (2008): Average time to presentation: 28 days 4.9%

    Kaohsiung J Med Sci. 2008 Jan;24(1):45-9Lateralization of cantilever eff

    Post op care
    No immobilization utilized Return to full ADLs as soon as tolerated Limit forward flexion ~ 3-4 weeks Pin removed under local anesthesia 8 12 weeks post-op

    Problems with pin


    Limited sizes Migration Static distraction (fully treaded pins) Pin irritation

    Plate vs Pin vs Non-op

    Pinning: 100% union within 2-4 months Shorter hospital stay Plate: 23.5% scar related pain 17.5% prominent hardware & discomfort Nonop 23.5% nonunion 29.4% cosmetic complaints 6% malunion

    AAOS 2005

    Plate or Pin?
    Plate or intramedullary fixation can be considered for both However, both have their limitations Plate fixation is probably ideal with: transverse, simple fractures nonunions with bone loss For all the rest, consider IM fixation

    Lee et al, Orthopedics. 2007, Nov;30(11):959-6

    Associated injury
    1. 2. 3. 4. 5. Brachial Plexus Injuries Vascular Injury Rib Fractures Scapula Fractures Pneumothorax

    Rehabilitation
    Most fracture heal in about 3 months. Rehabilitation exercises will begin as soon as patient can tolerate motion with very gentle exercises (pendulum exercises) designed to regain motion.

    Prognosis
    Generally excellentshoulder has the largest range of motion of any joint in the body. Even if the fracture fragments do not heal exactly in their normal position,the shoulder joint can easily compensate and provide with a well functioning shoulder joint.

    Thank you for your attention

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