Remind yourself of the anatomy of the clavicle
What age groups are clavicular fractures common in?
HINT: bimodal
- Adolescents & young adults
- 60yrs (onset of osteoporosis)
What classification system is used to classify clavicular fractures?
Allman classification
Describe the Allman Classification
Type 1
- # middle third
- 75% (as middle third is weakest)
- Generally stable
- But significant deformity present
Type 2
- # lateral third
- 20%
- When displaced, they are unstable
Type 3
- # medial third
- 5%
- Associated multi-system polytrauma
- May be associated with neurovascular compromise, pneumothorax or haemothorax
Describe how the medial and lateral segment of clavicle will displace in a #clavicle
- Medial: elevate due to SCM
- Lateral: depressed due to weight of arm > strength/support from trapezius
Describe some common mechanisms of injury for #clavicle
- Direct trauma
- Indirect trauma e.g. fall onto shoulder
State symptoms of a #clavicle
- Pain
- Sudden onset
- Localised
- Severe
- Worsened by active movement of arm
What might you find on examination of someone with #clavicle
- Tenderness over clavicular region
- Deformity (medial elevation, lateral depression)
- Open injuries
- Threatend skin (tented, tethered, white & non-blanching skin. May convert to open injury)
What must you assess for if someone presents with #clavicle?
Neurovascular compromise
What investigations would you do if you suspect #clavicle?
- X-ray of clavicle (AP and modified axial)
- ?CT: might be needed to asses medial clavicle injuires as these can be hard to assess on x-rays
Discuss the management of #clavicle
Most managed conservatively even if there is significant deformity.
- Sling (to support elbow& improve deformity. Kept on until regain pain-free movement)
- Encourage early movement of shoulder
Surgery is required for open fractures. Surgery for other #clavicle is controversial. ORIF required if fracture failed to unite.
State some potential complications of #clavicle
- Non-union
- Neuorovascular injury
- Puncture injury to lung resulting in pneumothorax or haemothorax
What is the healing tiem for clavicular fractures?
4-6 weeks
Remind yourself of the anatomy of the humerus
Who are humeral shaft fractures common in?
HINT: bimodal
- Younger pts (high energy trauma)
- Older pts (low impact, osteopenia/osteoporosis)
State some risk factors for humeral shaft fractures
- Age
- Osteoporosis
- Previous fractures
State typical mechanism of injury in humeral shaft fracture
- Fall on outstretched limb
- Fall laterally onto adducted limb
What are symptoms of humeral shaft fracture?
- Pain
- Deformity
- If radial nerve involved:
- Reduced sensation dorsum 1st webspace
- Weakend wrist extension
What might you find on clinical examination of a pt with humeral shaft fracture?
- Deformity
- Weakness wrist extension
- Reduced sensation over dorsal 1st webspace
- Open wounds
What must you assess when examing a pt with #humeral shaft?
Neurovascular status
Where do majority of humeral shaft fractures occur?
Medial third
What nerve is at risk in #humeral shaft and why?
Radial nerve as it passes through radial groove then runs along lateral edge of humeral shaft
The radial nerve is most likely to be damaged in what type of humeral shaft fracture?
- Holstein-Lewis fracture
- Fracture to distal 1/3 of radius
- Results in entrapment of radial nerve
*Requires surgical management
What investigations are required for humeral shaft fractures?
X-ray: AP & lateral
