EASIEST WAY TO LEARN UPPER EXTREMITY FRACTURES FOR CLAVICLE

Upper limb sustains a wide variety of fractures

CLAVICLE

 

 

CLAVICULAR FRACTURE

• Common fracture in all age especially in children
• A clavicle fracture or broken collar bone as it is also known is a fracture of the clavicle bone which runs along the front of the shoulder to the breast bone or sterenum in the middle of the chest.
• A clavicle fracture is a bone fracture in the clavicle, or collarbone. It is often caused by a fall onto an outstretched upper limb or hand (a FOOSH), a fall onto a shoulder, or a direct blow to the clavicle. Many research projects are underway regarding the medical healing process of clavicle fractures.

ALLMAN CLASSIFICATION

* The most common system, created by Allman, in which the clavicle is divided into thirds ^[1] :

• Group I fractures: Middle third injuries of clavicle 80%
  
  
• Group II fractures: Distal(outer) third injuries 15%
  Fractures involving the acromioclavicular joint 28%
• Group III fractures: Medial (inner) third injuries 5%
  
  

  

Mechanism of injury:

• Direct traumatic impact or fall on the shoulder 87%
• Direct impact to clavicle 7%
• Fall on outstretched hand 6%
• From fall on the side
• Vigorous muscle contraction, seizures {rare}
• Pathological fracture {rare} 

Most common causes are:

* Road traffic accident {RTA}
* Sporting injuries



  Signs and Symptoms of a fracture may include:

• Sagging of the shoulder downward and forward.
• Inability to lift the arm because of pain.
• A grinding sensation when you try to raise the arm.
• A deformity or "bump" over the break.
• Bruising, swelling, and/or tenderness over the collarbone.

 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 towards injured side.

• Local bruising.

• Vascular complication are rare, but we must look for it by: check pulse, gently palpate root of neck.

• Outer third fracture are easily missed for acromioclavicular joint. 

Investigation 

 In Lab

• Complete blood count (CBC): If a vascular injury is suspected, to check the hemoglobin and hematocrit values
• Arterial blood gas (ABG): If a pulmonary injury is suspected or identified

Imaging studies

• Chest radiography: Obtain an expiration posterioanterior (PA) chest film (along with the above-mentioned ABG test) if a pulmonary injury is suspected or identified
• Radiography of the clavicle and shoulder
• Computed tomography (CT) scanning with 3-dimensional (3-D) reconstruction: To help evaluate displaced fractures
• Arteriography: If a vascular injury is suspected
• Ultrasonography

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 and Surgical.


Conservative Treatment

• Support the arm in a sling until the pain subsides, usually 1-3 weeks
• Figure of 8- bandage
• Clavicle ring
• Analgesics
  
  

Surgical treatment:

Internal fixation plate.

 Physiotherapy Management

• Use ice: Ice the injured shoulder for 15 minutes three times per day as needed to help reduce pain, swelling, and inflammation. Use a sling: Keep your injured arm in a sling for three to four weeks post-injury to help support the clavicle as it heals.

• Rehabilitation: The patient should be instructed regarding hand wrist and elbow exercises during immobilization.And regarding shoulder exercises once fracture healed.