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Diagnosis and Treatment of Clavicle Fractures

Diagnosis and Treatment of Clavicle Fractures. Audience: Students in Health Care By Stephen Altano. Anatomical Review. The medical portion of the Clavicle attaches to the sternum The Lateral portion attaches to the acromion process of the scapula

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Diagnosis and Treatment of Clavicle Fractures

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  1. Diagnosis and Treatment of Clavicle Fractures Audience: Students in Health Care By Stephen Altano

  2. Anatomical Review • The medical portion of the Clavicle attaches to the sternum • The Lateral portion attaches to the acromion process of the scapula • Respectively comprising the acromioclavicular and sternoclavicular joints

  3. Anatomy continued • Prevents anterior displacement of the scapula • Enables full range of motion of the arm • The Medial epiphysis is the last to ossify • Fuses at about 25 years old • The superior portion is not protected by muscle, making it vulnerable to injury

  4. Mechanisms of Injury • The clavicle is most commonly fractured where the concave portion meets the convex • Mechanisms include; • Falling on tip of shoulder • Falling on outstretched arm • Direct impact • Clavicle fractures occur most commonly during Contact Sports • Is of the most common sports fracture • Football Fracture Video Example

  5. Classifications

  6. Diagnosis Did you hear any sounds? I HERD A CRACK!

  7. History • Athlete will describe a related mechanism • Complain of hearing a crack and crepitus • Have severe pain along the shaft of the clavicle • Can present neurological symptoms due to underlying neurovascular systems • Medical Emergency

  8. Observation • Patient will be guarding • Holding arm with head tilted towards involved side • Obvious deformity will be present • Edema and ecchymosis

  9. Motion, Strength, and Tests • All Motions will be limited • Patient will be apprehensive towards any movement • Strength testing is contraindicative • Percussion tests will be positive

  10. Treatment

  11. Immediate Care • Ice • Sling and Swathe • Send to Emergency Room • X-Rays

  12. Surgical Intervention • Most fractures are treated without surgery • Surgical Techniques • Plates and Screws • Pins

  13. Surgical Intervention • Indications for Surgery • Neurovascular compromise • Excessive raised skin • Open fracture • Associated scapular fracture

  14. Non-operative Treatment • Patient should be immobilized for up to six weeks • Can begin Range of motion exercises during immobilization period • All exercises should be pain free • Strength exercises should begin with isometrics and progress as motion is improved

  15. Rehabilitation

  16. Rehabilitation • Should be progressed based on symptoms and pain free activity • Therapeutic Modalities • Ice • Compression • Effleurage • Electric Stimulation • Ultrasound • Range of motion exercises • Passive • Active Assistive

  17. Rehabilitation • Cardiovascular endurance • Stationary bike • Treadmill • Strength Exercises • Therabands • Manual resistance • Free weights • Plyometrics • Functional Activities • Sport or Job specific

  18. Prognosis • Depends on type of fracture and patient • Typically 6 weeks for non-contact activities • Up to 12 weeks for contact sports • Important to Remember each case is unique

  19. Return to Activity Criteria • Full range of motion • Strength is equal to uninvolved limb • No point tenderness over fracture site • Able to perform functional testing • Cleared by a physician • Psychologically ready

  20. Sources • Ashwood N, Moonot P. Clavicle fractures. Trauma. 2009;11:123-132. • HouglamPA. Therapeutic Exercise For Musculoskeletal Injuries. 3rd ed. Champaign, IL: Duquesne University; 2010. • Pujalte GGA, Housner JA. Management of clavicle fractures. Current sports medicine reports. 2008;7:275

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