Clavicle Fractures
Cards (8)
- Anatomy:
- the only bony attachment of the scapula, so the only thing connecting the upper limb to the rest of the spine
- Acromioclavicular and coracoclavicular ligaments attach clavicle to scapula laterally
- Sternoclavicular and costoclavicular ligaments attach clavicle to scapula medially
- Subclavius and sternocleidomastoid attachments of clavicle protects the brachial plexus and the lung subclavian vessels
- Clinical Presentation of Clavicle Fractures:
- mechanism
- FOOSH
- direct blow
- fall onto shoulder
- incidence
- 5 to 10% of all fractures
- most common childhood fractures
- Classification of Clavicle Fractures:
- lateral class/third - makes up 15% of clavicle fractures
- middle class/third - makes up 80% of clavicle fractures
- medial class/third - makes up 5% of clavicle fractures
- Management:
- typically conservative treatment
- usually with a broad arm sling - supports weight of the arm so its not pulling down on the distal fragment of the clavicle and decreases activity around sternocleidomastoid, so theres not as much upward pull of the medial segment
- need early mobilisation of the glenohumeral joint
- fracture clinic
- analgesia to control pain
- Comminuted/Displaced Clavicle Fracture:
- orthopaedic opinion needed to determine whether internal fixation surgery would be appropriate
- Comminuted/Displaced Clavicle Fracture:
- orthopaedic opinion needed to determine whether internal fixation surgery would be appropriate
- Comminuted/Displaced Clavicle Fracture:
- refer to orthopaedics if:
- its severely displaced/comminuted
- neurovascular compromise
- open
- skin tenting
- Suggested Rehab Ideas - Depending on surgical intervention and usually protocol lead:
- week 1 - shoulder pendular, grip strength, isometric exercises
- week 2 to 4 - shoulder passive ROM, elbow active ROM, gentle proprioception
- week 4 to 8 - shoulder active ROM, strength (esp rotator cuff), proprioception
- week 8 to 12 - increase active ROM (aim full), increase strength and endurance
- week 12 to 18 - strength, sports specifics drill where appropriate
- general advice - dont lift upper limb above 70 degrees for the first 4 weeks, sling for the first 3 to 4 weeks