Case Presentation

Close Fracture
middle right clavicula

Susnari Ahmad
111 2015 1149

SUPERVISOR:
dr. Ariyanto Arief, M.Kes, Sp.OT
ADVISOR :
dr. Stefan
 Patient’s Identity
Name : Mr. A
Age : 19 years old
Sex : Male
Address : Jl. Latasakka No. 43 Kel.
Lumpue Pare-pare
Work : College student
Date of admission : December, 23 2017
Medical record : 141442
 History Taking
• Chief Complain : Pain in the right shoulder.
• Anamnesis : Patients arrived with a right shoulder pain
suffered from less than 4 hours before admitted to Andi
Makkasau Hospital due to traffic accident. History loss level of
conciousness (-), headache (-), projectile vomitting (-)
• Mechanism of Trauma : Patient was riding his motorcycle and
hit by another motorcycle from opposite side.
•Patient right hand dominant.
 Primary Survey
Airway and C-spine • Airway : Patent, clear
control • C-spine control : clear

• Inspection: RR: 22x / min, Right left symmetric

chest movement, spontaneous breath, no wound.
Breathing • Palpation: Tenderness (+), crepitation (-)
• Percussion: Sonor
• Auscultation: Vesicular S/D

• BP 130/70 mmHg, Breathing 22x /min, Pulse

Circulation 92 x /min lift strongly palpable, regular.

• GCS E4V5M6 Composmentis, pupil isokor Ø

Disability 2,5mm/2,5mm.

Exposure • Temp 36.0°C.

 Secondary Survey
Right Shoulder Region
Look Deformity (+), swelling (+), hematoma (+), wound (-)
Feel Tenderness (+)
Move Active and passive movement of shoulder can not be
evaluated due to pain
NVD Good sensibility, pulsation radialis and ulnar artery are
palpable, CRT <2 seconds. extend thumb (+),
 Clinical Photo

CLINICAL FINDING
Radiologal Finding

Photo thorax Sinistra AP

 Items
Laboratory Finding
Result Unit N Value
Hematology:
WBC 20,7 103/ul 4-12
Eosinofil 154 % 2-4
Basofil 148 % 0-1
Netrofil 20,7 71.5 % 50-70
Limfosit 1,85 23.9 % 25-50
Monosit 3,0 3.16 % 1-6
RBC 4,77 106/ul 3,8-5,2
Hemoglobin 13,8 g/dl 12,8-16,8
Hematokrit 41,8 % 35-47
MCV 88 Fl 80-100
MCH 29.0 Pg 26-34
MCHC 33,0 g/dl 32-36
PLT 204 103/ul 150-450
Items Result Unit N Value

Imuno-Serologi:
Negative
HBsAg (Kualitatif)
Negatif
Hemostasis:
CT
BT 9’00’’
< 15’00”
1’15’’
Minutes 1’00” – 3’00”
minutes
 Resume
• 19-year-old man arived to Andi Makkasau Hospital with pain in
his right shoulder, Can't be moved since about 4 hours of SMRS.
The man was got the traffic accident when he was rode his
motorcycle
• Primary survey clear.
• Secondary survey: localis status: Regio sholder dekstra.
• Look: deformity (+), swelling (+), hematoma (-), wound (-).
• Feel: tenderness (+)
• Move: difficult to evaluate due to pain. NVD within normal limits.
• Investigations of Thorax AP photos:.
 Diagnosis

Closed Fracture
1/3 middle right clavicula
 Planning of Diagnosis
Non Operatif Non Education for the patient about his
Medikamentosa condition
Arm sling
Medikamentosa
• IVFD Ringer Lactate 20 tpm
• Analgetik: Ketorolac inj.
1amp/8j/i v

Operatif Open Reducation External Fixation (ORIF)

• ANATOMI
 Fracture clavicula
Fracture → a break in the structural continuity of bone, cartilage,
joint and growth plate
If overlying skin remains intact: closed fracture
If skin not intact : open fracture
EPIDEMIOLOGY
In adults the incidence of clavicular fractures is about 40
cases from 100,000 people, with the female male ratio
being 2: 1. The most common midclavicula fractures are
about 80% of all clavicula fractures, while the lateral
fracture is about 15% and the medial portion about 5%.
ETIOLOGY

TRAUMA NON TRAUMA

Trauma of Outstrached
Shoulder Hand
 Classification of Fracture
Robinson (1998)

fractures in the middle third of clavicula bone(80% incidence)

1
clavicula fractures in the lateral third . (15%).
Divided into 3 types:
2

Type 1 • those with the coracoclavicular ligaments intact

• those where the coracoclavicular ligaments are torn or

Type 2 detached from the medial segment but the trapezoid
ligament remains intact to the distal segment,

Type 3 • factures which are intra-articular. .

3 clavicula fractures in one-third medial (5%)

PATOFISIOLOGI
In the middle of claviculas bone is not reinforced by
muscles or ligaments like in the distal and proximal
regions of the clavicula. The middle clavicula is a
transition point between the lateral and medial sections
 Diagnose
History and Mechanism of Trauma

Physical Examination

X-ray Thorax with Anteroposterior

Anamnesis
• History of trauma
- Trauma can occur due to a traffic accident, fall onto
shoulder (e.g., football,hockey)
• Pain
• swelling
• Impaired limb function or motion abnormality
• Deformity
Physical Examination
• Inspection: deformity, swelling, hematoma.

• Present with tenderness, crepitus

• Decreased range of motion at the shoulder,

depending on the location of the fracture

• NVD evaluation
Treatment
NON OPERATIVE
Arm sling

OPERATIVE
open reduction with internal
fixation (ORIF).
 Complication
EARLY COMPLICATION LATE COMPLICATION

- Injury to blood vessels and

nerve (a.subclavia),plexus -Mal union
brachialis - Non union (rarely)
- Pneumouthorax