Here are the images again:
There is a right middle third clavicle fracture and right scapula fracture!
Scapula Fractures:
- Relatively uncommon
- Many associated injuries, which can be LIFE-THREATENING: hemothorax, pneumothorax, pulmonary contusion, humeral fractures, skull fractures, or splenic injury
- Treatment: REMEMBER to treat life-threatening injuries FIRST! Scapula treatment: short-term immobilization with sling.
Clavicle Fractures
Background
Because of its position, the clavicle can be fracture easily. Most common mechanism: fall directly onto the lateral shoulder. These fractures are divided into groups:
Group I (middle third): ~80%
- Occurs medial to coracoclavicular ligament
- Displaced upward because of the pull of the sternocleidomastoid muscle
- Mechanism: direct force to the lateral shoulder from fall, sporting injury, or MVA
Group II (distal third): 15%
- Occurs lateral to the coracoclavicular ligament
- Mechanism: direct blow from the top of the shoulder
Group III (medial third): 5%
- Mechanism: direct blow to the anterior chest
- Injuries to this area are accompanied by other serious injuries – tremendous force is needed to cause this type of fracture
Physical Exam
Perform a neurovascular exam
- Possible brachial plexus injury
- Decrease pulses can indicate subclavian artery injury
- Venous stasis or discoloration or swelling can indicate a subclavian venous injury
Pulmonary injury:
- Diminished breath sounds can indicate a pneumothorax
Concomitant injury:
- Scapula injury
- Ribs injury
Workup
Xray
- These will be able to delineate fracture and displacement
- Consider obtaining chest xray if suspicious of pneumothorax or other lung injury such as hemothorax
- Consider rib xray if suspicious of rib injury
CT
- To further evaluate displaced fractures
- In medial clavicle fractures: can show posterior displacement of fracture or evaluate for injuries to neurovascular structures
Angiogram
- Only if suspicious of vascular injury
Treatment
Group I fracture:
- Mostly nonoperative – sling or figure-of-eight brace
- Operative if: severely displace or shortened > 2cm; comminuated with displaced transverse z-shaped fragment; neurovascular compromise; open fracture
Group II fracture:
- Surgical repair: because nonunion rate is high
Group II fracture:
- Nonsurgical
- Sling
References:
http://emedicine.medscape.com/article/1263076-overview
http://emedicine.medscape.com/article/92429-overview
jwang
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