Injuries of shoulder girdle
Is an S-shape long, curved ,tubular bone , lies horizontally
a cross the root of neck .
It articulate with sternum medially to form sternoclavicular
Also articulate with acromion process of scapula at
acromioclavicular joint and acromioclavicular ligament .
the muscles inserting on clavicle are : sternocleidomastoid,
And subclavius muscles .
The subclavian vessels and brachial plexus lie posterior to
Fractures of the clavicle:
common fracture in all ages
especially in children .
It is 2 – 10% of all fractures .
Mechanism of injury :
Direct traumatic impact or fall on the shoulder 87% .
Direct impact to clavicle 07% .
Fall on outstretched hand 06% .
From fall on the side .
Vigorous muscle contraction , seizures [rare] .
Pathological fracture [rare] .
Most common causes are :
Road traffic accident [RTA]
Allman classification : according to site of
group 1: Fracture mostly occur in the
middle one third of clavicle 80% .
group 2: The fractures of outer third is 15% .
Fractures involving the acromioclavicular joint 28% .
group 3: fracture of inner [medial] third 5% .
Why does the fracture occur in middle
third more ?
It is the thinnest part of the bone .
It is the junction of the tow main curves of shaft .
Site of entrance of nutrient artery .
common pattern of fractures of
clavicle are :
1 - Green stick fracture :
Common at the junction between
middle and outer third .
Common in children .
4 - With greater displacement :
•There is over lapping and shortening .
Clinical presentation :
pain and tenderness at site of injury .
Obvious deformity and swelling sometimes
Patient come support his injured limb with other
hand and head tilted
toward injured side .
Local bruising .
vascular 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 .
- Clinical picture examination .
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 assessment .
arteriography : if vascular injury suspected .
The aim is to provide support for the weight of the
Fracture of clavicle unite with or without treatment .
Healing occurs usually in 3-6 weeks .
It may be :
conservative or surgical .
Conservative treatment :
Support the arm in a sling until the pain subsides , usually 1-3
Figure of 8- bandage .
Clavicle ring .
The patient should be instructed regarding hand
wrist and elbow exercises during immobilization .
And regarding shoulder exercises once fracture
Surgical treatment :
Rarely indicated , except in :
- lateral one third fracture .
- presence of neurovascular injury .
- non union cases .
Internal fixation plate .
Ununion : treated by internal fixation and bone grafting .
Neurovascular injury [rare] . .
Stiffness of shoulder in elderly .
Ulnar neuropathy .
Early : [subclavian or carotid artery injury
,pneumothorax and hemothorax ,brachial injury ]
Is a flat triangular bone that lies on the posterior thorax wall
between 2-7 rib.
It envelope by :
Attached to clavicle at acromioclavicular joint ,secured by
acromioclavicular ligament .
Articulate with humerus at glenohumeral joint .
Attached to thorax in scapulothoraxic joint .
Fracture of scapula :
Fractures of scapula are uncommon because of
scapula location and surrounding muscles whitch
protect it .
-Fractures of scapula
are result of high energy
trauma with high incidence
Of associated injuries
by 60-98 % .
Associated life threatening injuries with scapula # :
splenic or liver laceration
brachial plexus injury
Fractures of scapula are classified
according to location :
body fracture 50 % .
neck fracture 5-30 % .
glenoid fracture 10 % .
Coracoid fracture 8 % .
Acromion fracture 7 % .
Mechanism of 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 on shoulder .
- fall on outstretched hand .
# of glenoid : direct blow to lateral aspect of shoulder .
or impaction of humeral head in to glenoid fossa .
# of coracoid process :
direct blow or shoulder dislocation .
# of acromion :
direct down ward blow to shoulder .
Clinical picture :
-Brusing over scapula or chest area .
-Pain in movement .
-Swelling around back of shoulder .
-Tenderness at site of # .
Arm is held immobile .
After initial assessment , according to advanced trauma
life support [ATLS] principles , radiograghic evaluation is
indicated as soon as possible as patient stable .
X – ray :
Anteroposterior view lateral axillary view .
C T scan :is useful in glenoid or body # . .
Reduction is usually unnecessary .
Patient wears a sling for comfort and from start
Check repeatedly for dislocation of the shoulder .
# of body by :
conservatively by analgesics and simple
sling to rest shoulder for 2-3 weeks .
# of acromion process :
Un displaced :
sling for 3-4 weeks for rest shoulder.
acromion should be reduced and fixed .
# of coracoid :
conservatively in major , using a sling for 2-3
Vigorous exercises should be prohibited for 2 m .
If there is marked displacement > open reduction .
# of neck and glenoid :
- sling for 2-3 weeks
- if there is displacement > shoulder spica after reduction .
- open reduction > indicated if there is isolated glenoid rim
fractures associated with dislocation or subluxation of
Malunion non union > rare
Glenohumeral arthritis .
Limitation in range of motion .
After surgery :
post traumatic arthritis
rotator cuff dysfunction
Scapular fracture should alert the surgeon to
presence of other injuries .
Sever chest injury should also raise suspicion
of possible scapular injury .