Fracture & Dislocation of Clavicula

dr Erwien Isparnadi Sp.OT

Oleh:
Betty Rachma
Ayu putri haryani
Abdul malik fajri
Introduction
 common injuries (2.6%-4% of adult fractures and 35% of
injuries to the shoulder)
 Hippocrates : “when a fractured clavicle is fairly broken
across it is more easily treated, but when broken obliquely it
is more difficult to manage”
 most common in younger patients with the greatest
incidence in the second and third decades
 The aetiology : sports injury and, to a lesser extent, a fall
(most frequent cause among the elderly)
anatomy
Clasification
 Allman divided clavicle fractures by anatomical site into 3
groups;
 Group 1 being fractures to the middle third
 Group 2 being fractures distal to the coraco-clavicular ligament
 Group 3 relating to fractures of the proximal third of the
clavicle
 Neer went further and subdivided clavicula fracture into
three groups; undisplaced, displaced, and intra-articular.
 The displaced types were then divided into 2a or 2b,
depending on the presence of injury to the coraco-clavicular
(CC) ligaments.
 Thus a type 2a injury represents a fracture medial to both
conoid and trapzezoid elements of the CC ligaments, with
the shaft displacing superior relative to the lateral end
 A type 2b injury represents a fracture of the lateral end of the
clavicle, with disruption of the conoid portion of the CC
ligamen
Type 1, Middle third
Type 2, lateral third
Type 3, Proximal third
Assesment
 Anamnesis : presenting complaint, including mechanisme of injury
 Physic diagnostic : examination on both shoulder and arm,
differing limb blood pressures may be present if theres a vascular
injury
 Radiography :Patients should also have a plain antero-posterior
(AP) X-ray
 performed in the emergency department. Other projections of
the clavicle may be performed after liaising with a radiographer,
such an apical oblique view of the clavicle with the patient
standing at 45 degrees toward the beam and the beam angled 20-
30 degrees
Treatment
The majority of clavicle fractures are treated non-operatively
with good outcomes. Measures such as an arm sling, analgesia
and, in the case of comminutive fractures, which is impossible
to be conservatively treated, operative way will be the choice.
Mid Shaft Clavicular Fracture
 Undisplaced mid-shaft fractures are generally managed non-
operatively.
 displaced mid shaft fracture can be manage by non-
operatively,
 Operatively use platting such as Knowles pins, Rockwood
pins, Hagie Pins or titanium elastic nails
Lateral end fracture
 Undisplaced mid-shaft fractures are generally managed non-
operatively.
 Displaced lateral clavicle fractures are often treated
operatively with conservative measures being associated with
high rates of non-union
 Non-operative treatment is generally used in those patients
who are low demand, elderly or frail
 In the case of a standard distal clavicle plate, three screws (a
minimum of two) should be placed in the distal fragment to
provide sufficient stability
Medial end Fracture
 Because of the close proximity of the mediastinal structures,
formal fixation is considered only in the event of marked
displacement of the clavicle, with a risk to underlying
structures
Dislocation
 Dislocation of Sternoclavicular join
 Dislocation of acromioklavikular (AC) joint
 Sternoclavicular joint
 The patient complained of mild to
moderate pain, especially with
movement of the upper limb.
 a little swelling and pain during
palpation, but instability was not
found.
 Sternoclavicular joint describe on 2 type, there is:
 Sternoclavicular joint anterior
 Sternoclavicular joint posterior
Sternoclavicular joint dislocation
(posterior)
 clavicle will appear less prominent on palpation. (shoulder
will pushed forward when compared with the normal
shoulder)
 Discomfort increased when the patient is placed in supine
position, the shoulder is not affected in a horizontal position
compared with healthy shoulders
 Some treatment options include open reduction for retrosternal
dislocation.
 closed reduction is considered the treatment of choice, especially
if the patient presents within 24 hours. A sack of sand or other
cushioning placed between the shoulder then pulled shoulder
lateral and ipsilateral arm in abduction position
 Sling figure of eight used after reduction for 4-6 weeks to help
the healing ligament
 sternoklavikular (SC) joint anterior
dilocation
 Patients with anterior dislocation usually
complain of pain in the SC joint, which
increases with movement of the arm;
atraumatic cases have only mild symptoms
 Acromioclavicular dislocation
 AC Joint Injuries often occur as a result of a
direct blow to the tip of the shoulder. This
forces the acromion process of the down,
beneath the clavicle. In addition, the AC Joint
injury can occur as a result of the upward
force on the long axis of the humerus in the
fall with direct impact when the wrist in a
straight position.
 Usually the shoulders are in a position of
adduction and flexion
Rockwood classification
 Surgical options for joint instability acromioklavikular
including (1) coracoklavikular ligament reconstruction with
or without excision of the distal clavicle or (2) stabilization
coracoklavikular with ligament reconstruction
coracoklavikular
 Conservative therapy  stage I-III
 Operative therapy  stage IV-VI
 Handling directly on soft tissue injury consists of a ricer
protocol - rest, ice, compression, elevation and referral.
RICE protocol should be followed for 48-72 hours. The goal
is to reduce bleeding and damage in the joints.
 Arm immobilized in a sling at least two days for minor
injuries or six weeks for more severe cases.
 No HARM protocol should also be applied - no heat, no
alcohol, no running or activity, and no massage. This will
reduce swelling and bleeding in the injured area