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 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
.
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 87%

shoulder
Direct impact to 07% . .
clavicle Fall on 06%
outstretched hand .
Vigorous
From muscle
fall on contraction ,
the side [rare]
seizures
. Pathological fracture .
[rare] .
Mechanism of
injury
Most common causes
are :

Roadtrafficaccident
[RTA]

Sporti injuri
ng es
 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%
.
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 .
2 - Un displaced
fracture in:
3 - Separation of bone
end :
4 - With greater
displacement
Thereis over lapping and :
shortening . •
 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 .
 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 .
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
 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 .
 Conservative
treatment :
Support the arm in a sling until the pain subsides ,
usually 1-3 weeks .

Figure of 8-

bandage .

Clavicle ring
Rehabilitation :

The patient should be instructed

regarding hand wrist and elbow
exercises during immobilization .
And regarding shoulder exercises once
fracture healed .
Surgical treatment :

Rarely indicated , except in :

- lateral one third fracture .
- presence of neurovascular
injury .
- non union cases .

Internal fixation plate .

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