0071643192.pdf

ORTHOPEDICS

CLAVICULARFRACTURES

DIAGNOSIS

Classified by segment (distal third, middle third, or medial third)

TREATMENT/COMPLICATIONS

■ Distal third (group 2):Immobilization with sling; may require surgery if
associated with rupture of coracoclavicular ligament to avoid nonunion
■ Middle third (group 1 =80% of clavicle fractures):Reduction, immobi-
lization with sling
■ Medial third (group 3):Immobilization with sling; may be associated
with intrathoracic injuries and can be life-threatening if there is injury to
underlying vascular structures

STERNOCLAVICULARDISLOCATIONS

■ Very uncommon; usually result of MVC or sport injuries where the shoulder
is forcefully rolled forward
■ Anterior dislocations are far more common.

DIAGNOSIS

■ Patient typically has severe pain that is exacerbated by shoulder movement.
■ X-rays are usually not helpful. CT is the most helpful imaging study.
■ First-degree dislocation:Sprain, mild pain/swelling
■ Second-degree dislocation:Subluxation of clavicle with complete tear
of sternoclavicular ligament and sprain of costoclavicular ligament
■ Third-degree dislocation:Complete rupture with clavicle dislocation

TABLE 4.2. Types of Acromioclavicular Separation

TYPE OFAC

SEPARATION DESCRIPTION TREATMENT

1 Sprain of the AC ligament Sling, 1–2 weeks

Radiograph is normal.

2 Disruption of AC ligament with Sling and orthopedic

coracoclavicular (CC) ligament sprain referral; rehab

Distance between acromion and clavicle

is increased by ≤half clavicle width.

3 Both AC and CC are disrupted. Distance Sling and orthopedic

between acromion and clavicle referral; surgical fixation

is increased by full widthof clavicle. controversial

4 Clavicle displaced posteriorly For Types 4—6,

5 Clavicle displaced far superiorly sling and orthopedic referral

and anteriorly with likely surgical fixation

6 Clavicle displaced inferiorly