Here are the images again:

clavicle2

clavicle

 

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

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