Xray Vision: Answer

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

The following two tabs change content below.

• Bio
• Latest Posts

jwang

Latest posts by jwang (see all)

• Xray Vision Answer - May 24, 2015
• Xray Vision: My Arm Looks Funny…. - May 16, 2015
• Xray Vision: Limping Answer - April 27, 2015