Ortopedic

• Fracture of the clavicle: this bone is easily fractured in children, and almost united rapidly on conservative treatment, without complication

  
• In adults, clavicle fracture is caused by fall on out stretched hand. The outer fragment pulled downward by the weight of the arm, while the inner fragment is displaced superiorly and posteriorly by the pull of sternomastoid muscle

  
• Clavicle fractures can be divided according to the site of fracture

  • Group 1: fracture in the middle third of the clavicle (80-85%)
  • Group 2: fracture in the lateral third (10-15%)
  • Group 3: fracture in the medial third of the clavicle (5-8%)

  
• Clinical feature of clavicle fracture

  • Patient presented with pain and deformity. Careful examination is needed to exclude neurovascular injury

  
• X ray: usually standard AP view is enough for clavicle fracture

  
• Non-operative treatment for clavicle fracture

  • Arm sling immobilization for 2-4 weeks followed by gentle range of movement and exercises

  
• Indications for non-operative treatment of clavicle fracture

  • Stable non displaced or mildly displaced fracture
  • Pediatric age group

  
• Indications for operative treatment of clavicle fracture


  • Significant displacement with more than 2 cm shortening in demanding patient
  • Open fractures
  • Skin tenting by sharp fragment (impending open fracture)
  • Vascular injury (subclavian artery or vein)
  • Floating shoulder (clavicle fracture with scapular neck fracture)
  • Symptomatic non-union of clavicle fracture
  • Posteriorly displaced medial third fracture

  
• Complications of clavicle fracture

  • Early: Injury to vital structure like brachial plexus, subclavian vessels, or pneumothorax
  • Late: non-union, mal-union, stiff shoulder, prominent hardware

  
• Fracture of the scapula is uncommon, due to high energy injury

  
• Fracture of the scapula can be associated with other injuries, like rib fracture, clavicle fracture, spine injury, brachial plexus injury, pulmonary injury, pneumothorax, head injury, and vascular injury

  
• Fracture classification of the scapula

  • Coracoid fracture
  • Acromion fracture
  • Glenoid fracture
  • Scapular neck fracture
  • Scapular body fracture

  
• Imaging study for scapular fracture

  • X ray: AP view, scapular Y view, axillary lateral view
  • CT scan

  
• Non-operative treatment for scapular fracture

  • Arm sling for 2-3 weeks followed by early movement

  
• Indications for operative treatment of scapular fracture

  • Gleno-humeral instability due to glenoid fracture with more than 25%, and more than 5 mm displacement (intra-articular fracture displacement)
  • Displaced scapular neck fracture
  • Open fracture
  • Displaced coracoid or acromian fracture
  • Floating shoulder (scapular neck fracture with fracture clavicle or acromio-clavicular ligament)

  
• Acromio-clavicular joint (ACJ) injury is caused by direct blow to the shoulder or fall on the shoulder

  
• Stability of the ACJ

  • By the acromio-clavicular ligament and the coraco-clavicular ligaments (main stabilizers), joint capsule, and surrounding muscles (deltoid and trapezoid m.)
• Clinical features of ACJ injury

  • Pain, tenderness, and abnormal contour of the shoulder

  
• Imaging study for ACJ injury


  • AP view for both shoulder joints, axillary lateral view, cephalic tilt view (zanca view) stress view

  
• Classification of ACJ injury

  • Type 1: Acute sprain in acromio-clavicular ligament
  • Type 2: AC ligament is torn
  • Type 3: AC ligament and coraco-clavicular (CC) ligaments are torn
  • Type 4: AC and CC ligaments are torn with the clavicle displaced posteriorly
  • Type 5: Clavicle displaced superiorly
  • Type 6: Clavicle displaced inferiorly

  
• Non-operative treatment for ACJ injury

  • Indicated for type I, II, and most of type III injury. The patient advised for rest, ice, and arm sling for 3 weeks
• Fracture of the clavicle: this bone is easily fractured in children, and almost united rapidly on conservative treatment, without complication

  
• In adults, clavicle fracture is caused by fall on out stretched hand. The outer fragment pulled downward by the weight of the arm, while the inner fragment is displaced superiorly and posteriorly by the pull of sternomastoid muscle

  
• Clavicle fractures can be divided according to the site of fracture

  • Group 1: fracture in the middle third of the clavicle (80-85%)
  • Group 2: fracture in the lateral third (10-15%)
  • Group 3: fracture in the medial third of the clavicle (5-8%)

  
• Clinical feature of clavicle fracture

  • Patient presented with pain and deformity. Careful examination is needed to exclude neurovascular injury

  
• X ray: usually standard AP view is enough for clavicle fracture

  
• Non-operative treatment for clavicle fracture

  • Arm sling immobilization for 2-4 weeks followed by gentle range of movement and exercises

  
• Indications for non-operative treatment of clavicle fracture

  • Stable non displaced or mildly displaced fracture
  • Pediatric age group

  
• Indications for operative treatment of clavicle fracture

  • Significant displacement with more than 2 cm shortening in demanding patient
  • Open fractures
  • Skin tenting by sharp fragment (impending open fracture)
  • Vascular injury (subclavian artery or vein)
  • Floating shoulder (clavicle fracture with scapular neck fracture)
  • Symptomatic non-union of clavicle fracture
  • Posteriorly displaced medial third fracture

  
• Complications of clavicle fracture

  • Early: Injury to vital structure like brachial plexus, subclavian vessels, or pneumothorax
  • Late: non-union, mal-union, stiff shoulder, prominent hardware

  
• Fracture of the scapula is uncommon, due to high energy injury

  
• Fracture of the scapula can be associated with other injuries, like rib fracture, clavicle fracture, spine injury, brachial plexus injury, pulmonary injury, pneumothorax, head injury, and vascular injury

  
• Fracture classification of the scapula

  • Coracoid fracture
  • Acromion fracture
  • Glenoid fracture
  • Scapular neck fracture
  • Scapular body fracture

  
• Imaging study for scapular fracture

  • X ray: AP view, scapular Y view, axillary lateral view
  • CT scan

  
• Non-operative treatment for scapular fracture

  • Arm sling for 2-3 weeks followed by early movement

  
• Indications for operative treatment of scapular fracture

  • Gleno-humeral instability due to glenoid fracture with more than 25%, and more than 5 mm displacement (intra-articular fracture displacement)
  • Displaced scapular neck fracture
  • Open fracture
  • Displaced coracoid or acromian fracture
  • Floating shoulder (scapular neck fracture with fracture clavicle or acromio-clavicular ligament)

  
• Acromio-clavicular joint (ACJ) injury is caused by direct blow to the shoulder or fall on the shoulder

  
• Stability of the ACJ

  • By the acromio-clavicular ligament and the coraco-clavicular ligaments (main stabilizers), joint capsule, and surrounding muscles (deltoid and trapezoid m.)
• Clinical features of ACJ injury

  • Pain, tenderness, and abnormal contour of the shoulder

  
• Imaging study for ACJ injury

  • AP view for both shoulder joints, axillary lateral view, cephalic tilt view (zanca view) stress view