Fractures of the Clavicle (Dr Zahid

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@ Mechanism of Injury
1. 2. 3. 4. 5. Moderate or high-energy direct traumatic impacts to the shoulder (87%). Direct impact to clavicle. (07%) Fall on outstretched hand . (06%) Vigorous muscle contractions, seizures (Rare). Atraumatic ,pathologic (Rare).

@ Radiographic Evaluation Clavicle #:
1) Anteroposterior View

2) 30-degree Cephalic tilt view. No thoracic overlap.

3) Chest X-ray for comparison.

4)

CT scan usually indicated to best assess degree and direction of displacement. And to differentiate sternoclav joint dislocation from epiph. Injury in children.

Type II B Conoid torn. . Type II (Unstable) Typically displaced secondary to # medial to the coracoclavicula ligaments.Minimal displacement .Interligametous # . .@ Fractures Classification * Group I : Middle third (80% ) * Group II: lateral third (10-15%) Type I: . trepezoid attached to distal fragment. Type II A Both conoid and trepezoid remain intact and atteched to distal segment.# is medial to conoid tubercle on x-ray.i. keeping the distal fragment reduced while allowing the medial fragment to displace superiorly.e b/w conoid & trapezoid or b/w AC & CC ligaments.Ligamets still intact. # is in line with conoid tubercle on x-ray.

Comminuted @ Treatment Options for Group I (Middle third): Non-operative Sling / Brace (Immobilization till pt. Type V.Minimal displacement.Type III:(Stable) Extension to Acromioclav joint (Articular surface). Intact ligaments.(Remove after 8 wks ).Intraarticular. Surgical (2 wks immobilization) Recon Plating . TypeIII. Ex-Fix can be used in rare cases. becomes pain free). Indications for surgical treatment: 1) Open # 2) Neurovascular injury 3) Shortening of >2cm 4) Soft tissue interpositioning 5) Seizures disorders 6) Floating shoulder 7) Multiple trauma 8) Cosmetic 9) Quick recovery .Displaced. Type IV-Epiphyseal separation. TypeII. * Group III: Medial third (5%) Type I.

Opted in all displaced #.K-wires fixation. Tension band wiring (Most prefered) / PDS sutures. Plate and screw fixation. 2) Operative treatment Fractures healing occures within 6 to 10 weeks after surgery.@ Treatment of Distal-Third (Type II) Clavicle Fractures 1) Nonoperative treatment Chances of non-union or delayed union are much more as Compared to ORIF. Techniques for Acute Operative Treatment of Distal Clavicle #: . Techniques for Late Operative Treatment of Distal Clavicle # 1) Excision of distal clavicle With or without reconstruction of coracoclavicular ligaments (Modified Weaver-Dunn procedure) 2) Reduction and fixation of fracture . Coracoclavicular ligament reconstruction. Opted in undisplaced #. Single transacromial knowel pin.

* Restore length of the clavicle. internal fixation if non-operative treatment fails.Occasionally. 2) Degree of displacement (Marked). especially of scapulothoracic stabilizers. * Bone graft. .@ Complications of Clavicular # & its Treatment: 1) Non-union (o. * Rigid fixation with plate. 3) Neurological Sequele: .1% – 7%): Risk factors include. 1) Location of # (distal third).Initially treat with strengthening. 4) Post-traumatic arthritis . .Treatment is reduction and fixation of the fracture. 3) Primary ORIF (Periostel stripping). or resection of callus with or without osteotomy and fixation for malunions. Principles of treatment: 2) Clavicular Malunion .Consider osteotomy. 4) Open #. fracture fragments or abundant callus can cause brachial plexus symptoms.

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