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clavicle fracture.pptx
- 1. Which is the first bone to start ossifying ? A. Femur B. Clavicle C. Radius D. Sternum
- 2. Which is the last bone to complete ossification ? A. Calcaneum B. Femur C. Mandible D. Clavicle
- 3. Most common fracture in children ? A. Rib fractures B. Humerus fracture C. Clavicle fracture D. Femur fracture
- 4. The only long bone to undergo membranous ossification is A. Radius B. Ulna C. Clavicle D. Fibula
- 5. CLAVICLE FRACTURES Dr Udit Kumar Biswal Assistant Professor in Orthopaedics IMS & SUM Hospital
- 6. Facts about the clavicle Clavicle – Latin/middle French origin – “small key” 1st bone to start ossifying - @ 5 weeks gestation Last bone to completely ossify – 20-21 years Most common bone to fracture in children Only long bone with intramembranous type of ossification (2 centres)
- 9. Superior Shoulder Suspensory Complex • Suspends shoulder from axial skeleton • Both bony and ligamentous parts • Clavicle + scapula neck # is called floating shoulder injury
- 10. Mechanism of injury • Fall over point of shoulder - commonest • Fall on out-stretched hand (FOOSH)
- 11. Location wise classification • Middle 1/3 – Most common (80 %) • Lateral 1/3 – 10 % • Medial 1/3 – 5 % • Middle 1/3 a) Tubular part connecting two flat ends b) Lack of musculotendinous attachments
- 12. Signs and symptoms • Bump / deformity over clavicle • Abrasions/ contusions • Painful crepitus • Abnormal mobility of fractured ends • Cannot lift the arm • NEUROVASCULAR STATUS
- 13. Associated injuries • Subclavian artery/vein • Brachial plexus • Cervical spine • Scapula • Rib fractures • Hemothorax or pneumothorax • Open fractures
- 14. Investigations • Xray shoulder AP view • Xray chest with both clavicles AP • Xray cervical spine AP/lateral • CT scan a) Glenoid fractures b) Chest injuries • MRI scan a) brachial plexus injuries b) Lateral 1/3 fractures for integrity of coraco-clavicular and acromio-clavicular ligaments c) Cervical spine injury
- 15. Case example • Middle 1/3 clavicle # • Glenoid neck / scapula neck # • 3rd rib fracture • Cervical spine lateral mass fractures • Brachial plexus injury
- 16. Lateral 1/3 clavicle fracture
- 17. Treatment Conservative • 85-90 % of clavicle fractures treated conservatively • Longer period of immobilisation • Stiffness • Bump on healing • No scar, cosmesis • No implant issues Operative • Specific indications exist • Lesser period of mobilisation • Less chance of stiffness • No/ minimal bump on healing • Surgical scar • Implant prominence below skin is possible
- 18. First aid – Sling application
- 19. Conservative management • Arm sling • Figure of 8 bandage • Clavicular brace • Immobilisation – 4 to 6 weeks • Allow elbow and hand ROM
- 20. Operative management - Indications Open fractures Skin tenting, or impending rupture Displacement > 2cm Shortening > 2 cm Comminuted / segmental fractures Neurovascular injury Bilateral fractures Polytrauma with need for early mobilisation Patient demand – elite sports / cosmesis
- 21. Surgery – ORIF with plating
- 25. External fixation for open clavicle fractures
- 26. Complications Neurovascular injury – primary or secondary due to callus Malunion Non union Acromioclavicular joint arthritis Implant complications – migration/ prominence/ infection
- 27. Thank You