LITERATURE REVIEW

A. CLOSE FRACTURE REGIO CLAVICULA MEDICAL CONCEPT

1. DEFINITION
Close Clavicle Fracture is a disruption or disconnection of the clavicle bone caused by
direct and indirect trauma in the position of the arm being cut off or pulled out which is not
related to the fracture with the outside world. Usually this happens due to falling from a
motorized vehicle, as a result the sufferer when it comes will complain of pain when
moving the arm.
2. CLASSIFICATION
In general, clavicle fractures according to Armis (2002) are classified into three types,
namely:
1. Fractures in the middle 1/3 of the clavicle (75% - 80% incidence). In this area the bones
are weak and thin and generally occur in young patients.
2. Fractures or fractures of the clavicle occur distally (incidence 15%).
3. Fracture of the clavicle in the proximal 1/3 (5% of these cases are associated with
neurovascular injury).
3. ANATOMY AND PHYSIOLOGY
The clavicle is a bony prominence on either side of the front of the shoulder and the top of
the chest. In human anatomy, the clavicle is the bone that forms the shoulder and connects
the upper arm to the torso. The clavicle is the weight bearing of the hand, so if there is an
excessive load it will cause an overload of the bone.
The clavicle has an S letter. The larger medial arch goes forward, the smaller lateral arch
goes backwards. The medial end is connected to the sternum and is called the sternal
extremity, there is a small protrusion called the costal tuberosity to bind the clavicular
costal ligament. Lateral to the acromion (acrominal extremity), there is the costal
tuberosity and the subclavicular sulcus.

4. ETIOLOGY
Fractures of the clavicle are most often caused by a compression or compression
mechanism, most often due to a force that exceeds the strength of the bone where the
direction from the lateral shoulder can be due to a fall, sports accident, or motor vehicle
accident. Clavicle fractures are injuries that often result from a fall or a direct blow to the
shoulder. More than 80% of these fractures occur in the middle or proximal third of the
clavicle (Putra 2013). In the middle region of the clavicle bone is not strengthened by
muscles or ligaments as in the distal and proximal areas of the clavicle. The middle
clavicle is also the transition point between the lateral and medial sections. This explains
why fractures are more common in this area than the distal or proximal areas.

5. CLINICAL MANIFESTATIONS
Complaints of pain in the front shoulder, a history of trauma to the shoulder or a fall with a
hand position that is not optimal (outstreched hand)
1. Look, that is, in the initial phase of the injury, the client is seen holding his arm to his
chest to prevent movement. A large lump or deformity of the front shoulder is visible
under the skin and sometimes a sharp fragment threatens the skin.
2. Feel that there is tenderness in the front shoulder.
3. Move due to the inability to lift the shoulders up, out and behind the thorax. (Helmi,
2012).
6. PATHOPHYSIOLOGY
The first bones to undergo a process of ossification during embryonic development at the
fifth and sixth weeks. The clavicle, proximal humerus and scapula together form the
shoulder up, out, and behind the thorax. At the proximal part of the clavicle bone joins the
sternum is called the sternoclavicular junction. In the distal clavicle, fractures are generally
easy to identify because the clavicle is a bone that lies under the skin (subcutaneous) and is
relatively anterior. Because of its position under the skin, this bone is very prone to
fracture. Clavicle fractures occur as a result of strong pressure or a strong blow to the
shoulder. High energy pressing the shoulder or a direct blow to the bone will cause a
fracture (Helmi, 2012).

7. MANAGEMENT
According to Helmi (2012) the management of clients with middle 1/3 fractures, reduction
interventions are carried out. Interventions with the installation of a shoulder sling by not
encouraging the client to abduct the arm can be done until the pain subsides (usually 2-3
weeks). After that, active shoulder exercises should be carried out, this is especially
important for the patient. Fractures of 1/3 part that undergo severe displacement, for
example on examination where the coracoclavicular ligament is torn, usually cannot be
reduced closed. If left untreated, the fracture will cause deformity and in some fractures
will cause discomfort and weakness in the shoulder. Therefore, surgical therapy is
indicated through a supraclavicular incision, repositioned fragments and maintained with
internal fixation and then back to the clavicular trunk.

8. SUPPORTING EXAMINATION
According to (Huda and Kusuma, 2015) the supporting examinations that need to be
carried out are as follows:
a. X-ray, aims to determine the location / extent of the fracture
b. Bone scan, aims to show the fracture more clearly, identify soft tissue damage
c. Anteriogram, aims to confirm the presence or absence of vascular damage
d. Complete blood count, characterized by increased hemoconcentration, decreased
bleeding, increased leukocytes in response to inflammation
e. Creatinine, characterized by muscle trauma increases the creatinine load for renal
clearance
f. Coagulation profile, marked changes can occur in blood loss, transfusion or liver injury.

9. THERAPY
perform physical therapy by maintaining arm movement to prevent stiffness. Often the
patient will start doing exercises for elbow movement soon after the injury. In addition, the
treatment process can also be accompanied by taking drugs that can help relieve pain
during fracture healing.

10. COMPLICATIONS
Complications of clavicle fractures can include:
1. Early complications
a. Arterial damage (causing blood vessels to clog)
b. Compartment syndrome (tissue swelling)
c. Fat embolism syndrome (When fat enters the bloodstream and produces symptoms
within 1 day such as rash, decreased level of consciousness, and shortness of breath.
d. Infection (microorganisms that attack tissue)
e. Shock (sudden decrease in blood flow throughout the body).
2. Advanced complications
a. Mal union (a condition of broken bones that have undergone union with the fracture
fragments are in an abnormal position (poor position).
b. Non-union (fracture healing occurs 4 to 6 months after the initial injury and spontaneous
healing is unlikely to occur. Usually results from insufficient blood supply and
uncontrolled pressure at the fracture site).