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Injuries of shoulder girdle
clavicle fracture
scapula fracture
CLAVICLE :
Is an S-shape long, curved ,tubular bone , lies horizontally
a cross the root of neck .
It articulate with ster...
CLAVICLE ANATOMY
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 outstr...
Mechanism of injury
Most common causes are :
Road traffic accident [RTA]
Sporting injuries
Allman classification : according to site of
fracture :
group 1: Fracture mostly occur in the
middle one third of clavicle...
Why does the fracture occur in middle
third more ?
It is the thinnest part of the bone .
It is the junction of the tow mai...
common pattern of fractures of
clavicle are :
1 - Green stick fracture :
Common at the junction between
middle and outer t...
2 - Un displaced fracture in :
3 - Separation of bone end :
4 - With greater displacement :
•There is over lapping and shortening .
Clinical presentation :
pain and tenderness at site of injury .
Obvious deformity and swelling sometimes
occur .
Patient c...
vascular compilication are rare , but we must look
for it by : check pulse , gently palpate root of neck
.
Outer third # a...
Diagnosis :
- Clinical picture  examination .
investigation :
x-ray [AP view ] :
# is usually in middle third, outer fragm...
Treatment :
The aim is to provide support for the weight of the
arm .
Fracture of clavicle unite with or without treatment...
Conservative treatment :
Support the arm in a sling until the pain subsides , usually 1-3
weeks .
Figure of 8- bandage .
C...
Rehabilitation :
The patient should be instructed regarding hand
wrist and elbow exercises during immobilization .
And reg...
Surgical treatment :
Rarely indicated , except in :
- lateral one third fracture .
- presence of neurovascular injury .
- ...
Complication:
late :
Malunion .
Ununion : treated by internal fixation and bone grafting .
Neurovascular injury [rare] . ....
Scapula
Fractures of scapula …
Scapula :
Is a flat triangular bone that lies on the posterior thorax wall
between 2-7 rib.
It envelope by :
supraspinatus...
Fracture of scapula :
Fractures of scapula are uncommon because of
scapula location and surrounding muscles whitch
protect...
Associated life threatening injuries with scapula # :
pneumothorax
pulmonary contusion
arterial injury
abdominal injury
he...
Fractures of scapula are classified
according to location :
body fracture 50 % .
neck fracture 5-30 % .
glenoid fracture 1...
Mechanism of injury :
# of body : from sever direct trauma
- fall from height with direct landing on posterior aspect of t...
# of coracoid process :
direct blow or shoulder dislocation .
# of acromion :
direct down ward blow to shoulder .
Clinical picture :
Sight > swelling deformity ecchymosis erosion .
Touch > pain tenderness crepitation .
Pain exacerbated ...
Clinical picture :
-Brusing over scapula or chest area .
-Pain in movement .
-Swelling around back of shoulder .
-Tenderne...
Diagnosis :
After initial assessment , according to advanced trauma
life support [ATLS] principles , radiograghic evaluati...
Treatment :
Reduction is usually unnecessary .
Patient wears a sling for comfort and from start
movement.
Check repeatedly...
# of body by :
conservatively by analgesics and simple
sling to rest shoulder for 2-3 weeks .
# of acromion process :
Un d...
# of coracoid :
conservatively in major , using a sling for 2-3
weeks.
Vigorous exercises should be prohibited for 2 m .
I...
Complication :
Malunion non union > rare
Glenohumeral arthritis .
Limitation in range of motion .
After surgery :
local dy...
Notes :
Scapular fracture should alert the surgeon to
presence of other injuries .
Sever chest injury should also raise su...
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Clavicle fracture

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Clavicle fracture
Taiz University ,faculty of medicine and health sciences
By Dr : Wedad abdusalam

Published in: Health & Medicine
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Clavicle fracture

  1. 1. Injuries of shoulder girdle clavicle fracture scapula fracture
  2. 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 . the muscles inserting on clavicle are : sternocleidomastoid, And subclavius muscles . The subclavian vessels and brachial plexus lie posterior to clavicle .
  3. 3. CLAVICLE ANATOMY
  4. 4. Fractures of the clavicle: common fracture in all ages especially in children . It is 2 – 10% of all fractures .
  5. 5. 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] .
  6. 6. Mechanism of injury
  7. 7. Most common causes are : Road traffic accident [RTA] Sporting injuries
  8. 8. Allman classification : according to site of fracture : 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% .
  9. 9. 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 .
  10. 10. common pattern of fractures of clavicle are : 1 - Green stick fracture : Common at the junction between middle and outer third . Common in children .
  11. 11. 2 - Un displaced fracture in :
  12. 12. 3 - Separation of bone end :
  13. 13. 4 - With greater displacement : •There is over lapping and shortening .
  14. 14. Clinical presentation : pain and tenderness at site of injury . Obvious deformity and swelling sometimes occur . Patient come support his injured limb with other hand and head tilted toward injured side . Local bruising .
  15. 15. 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 .
  16. 16. Diagnosis : - Clinical picture examination . investigation : 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 .
  17. 17. Treatment : The aim is to provide support for the weight of the arm . Fracture of clavicle unite with or without treatment . Healing occurs usually in 3-6 weeks . It may be : conservative or surgical .
  18. 18. Conservative treatment : Support the arm in a sling until the pain subsides , usually 1-3 weeks . Figure of 8- bandage . Clavicle ring . Analgesics .
  19. 19. Rehabilitation : The patient should be instructed regarding hand wrist and elbow exercises during immobilization . And regarding shoulder exercises once fracture healed .
  20. 20. Surgical treatment : Rarely indicated , except in : - lateral one third fracture . - presence of neurovascular injury . - non union cases . Internal fixation plate .
  21. 21. Complication: late : Malunion . Ununion : treated by internal fixation and bone grafting . Neurovascular injury [rare] . . Stiffness of shoulder in elderly . Ulnar neuropathy . Refracture . Early : [subclavian or carotid artery injury ,pneumothorax and hemothorax ,brachial injury ]
  22. 22. Scapula
  23. 23. Fractures of scapula …
  24. 24. 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 .
  25. 25. 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 % .
  26. 26. Associated life threatening injuries with scapula # : pneumothorax pulmonary contusion arterial injury abdominal injury head injury splenic or liver laceration brachial plexus injury
  27. 27. Fractures of scapula are classified according to location : body fracture 50 % . neck fracture 5-30 % . glenoid fracture 10 % . Coracoid fracture 8 % . Acromion fracture 7 % .
  28. 28. 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 .
  29. 29. # of coracoid process : direct blow or shoulder dislocation . # of acromion : direct down ward blow to shoulder .
  30. 30. Clinical picture : Sight > swelling deformity ecchymosis erosion . Touch > pain tenderness crepitation . Pain exacerbated by movment .
  31. 31. Clinical picture : -Brusing over scapula or chest area . -Pain in movement . -Swelling around back of shoulder . -Tenderness at site of # . Arm is held immobile .
  32. 32. Diagnosis : 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 # . .
  33. 33. Treatment : Reduction is usually unnecessary . Patient wears a sling for comfort and from start movement. Check repeatedly for dislocation of the shoulder .
  34. 34. # 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. displaced : acromion should be reduced and fixed .
  35. 35. # of coracoid : conservatively in major , using a sling for 2-3 weeks. 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 shoulder .
  36. 36. Complication : Malunion non union > rare Glenohumeral arthritis . Limitation in range of motion . After surgery : local dyscomfort infection nerve injuries post traumatic arthritis rotator cuff dysfunction
  37. 37. Notes : Scapular fracture should alert the surgeon to presence of other injuries . Sever chest injury should also raise suspicion of possible scapular injury .

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