Plate 1-30 Shoulder
FRACTURES OF CLAVICLE
Fractures of lateral third of clavicle
Type I. Fracture with Type IIA. Fracture is Type IIB. Fracture is Type III. Fracture through
no disruption of medial to ligaments. between ligaments; acromioclavicular joint;
ligaments and therefore Both ligaments are coracoid is disrupted, no displacement. This is
no displacement. intact. trapezoid is intact. often missed and may later
Treated with simple Medial fragment may cause painful osteoarthritis
sling for few weeks. elevate. requiring resection arthro-
plasty.
Clavicle shaft
Lateral clavicle
fracture fragment
Coracoid
FRACTURES OF THE CLAVICLE
AND SCAPULA
FRACTURES OF THE CLAVICLE
Fractures of the distal third of the clavicle are classified Type IIB
as those involving the lateralmost portion of the clavi-
cle. A type I fracture involves the clavicle distal to the Fracture of clavicle in children
corticoclavicular ligaments and is without significant
displacement. Type II fractures involve the distal third Displaced fracture
of the clavicle in the region of the corticoclavicular of middle of right
ligaments. These fractures are often displaced based on clavicle with
the location of the fracture relevant to the corticocla- overriding
vicular ligaments. Those fractures that are medial to the
corticoclavicular ligaments have a stable lateral fracture
fragment, whereas those that have involvement of the
fracture lateral to the ligaments with disruption of the
corticoclavicular ligaments result in a displaced clavicle
segment. Type III fractures involve a contusion or com-
pression fracture of the distal third of the fracture at its
articular surface. Type I fractures are often treated by
nonoperative measures. Type II fractures with minimal
displacement can likewise be treated with nonoperative
treatment, whereas those with significant displacement
will often require fixation of the fracture and recon- Commonly caused by fall on
struction of the corticoclavicular ligaments by either outstretched hand with force Fracture immobilized with snug, commercially available
direct suture or ligament substitution. Type III frac- transmitted via shoulder to clavicle shoulder harness or figure-of-8 bandage for 3-4 weeks
tures are often treated nonoperatively, but in many
cases post-traumatic arthritis will result.
Midclavicular fractures involve the middle third
segment. These are very common fractures in all age
groups and one of the most common fractures through- appropriate, use of a figure-of-eight harness or sling is residual deformity in the area of the clavicle. Minor
out the body. In many cases, these fractures can be an effective means to decrease the use of the shoulder deformities often remodel over time, resulting in an
treated nonoperatively. Only when there is significant and to place the shoulder in a more favorable position. acceptable appearance to the contour of the shoulder.
comminution and displacement of the middle third A figure-of-eight harness places the shoulder in a posi-
fractures is early surgical treatment indicated. In tion of scapula retraction and helps to support the frac-
FRACTURES OF THE CLAVICLE IN CHILDREN
severely displaced fractures, significant malunion, non- ture and lengthen the clavicle to aid in reduction of the
union, or compromise of the neurovascular structures fracture fragments. Fracture healing with and without Fractures of the clavicle are among the most common
can result. In cases in which nonoperative treatment is internal fixation will result in callus formation with a fractures in children and can be caused by both direct
THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS 31
Plate 1-31 Musculoskeletal System: PART I
FRACTURES OF CLAVICLE AND SCAPULA
Fracture of middle third of clavicle (most Anteroposterior radiograph. Fracture of middle third of
common). Medial fragment displaced clavicle.
upward by pull of sternocleidomastoid
muscle; lateral fragment displaced
downward by weight of shoulder.
These fractures occur most often in children.
FRACTURES OF THE CLAVICLE
AND SCAPULA (Continued)
Fracture of middle third of clavicle best treated with snug Healed fracture of clavicle. Even with
trauma to the clavicle or indirect trauma from a fall figure-of-8 bandage or clavicle harness for 3 weeks or until proper treatment, small lump may
onto an outstretched arm. The clavicle in the children pain subsides. Bandage or harness must be tightened remain.
has great healing potential, and even with comminution occasionally because it loosens with wear.
or deformity these fractures heal and remodel better
than the same fracture type in adults. Most children Spine Acromion
without a closed clavicular fracture without neurovas-
cular injury will be successfully treated with closed non-
operative management. Use of a figure-of-eight brace
maintains a comfortable position of the fracture and
allows for healing. True fracture immobilization is not Coracoid process
achieved with this type of fracture, and pain manage-
ment is largely a matter of decreased activity level and Glenoid cavity
analgesic medication. In the child, early fracture healing
and decreased mobility of the fracture fragments occurs Neck
within 4 to 6 weeks after fracture. Solid fracture healing Neck plus lateral mass
takes considerably longer, and these patients should
avoid participation in any sports for 3 months and in
Body
any contact-type sport for 4 to 6 months.
FRACTURES OF THE SCAPULA Fractures of scapula
Scapular fractures often result from high-velocity
trauma to the chest wall. These fractures can often be
associated with other visceral or thoracic trauma,
including rib fractures. Glenoid rim fractures can occur
as a result of traumatic dislocations of the shoulder. The
anterior glenoid rim fractures often result from anterior
dislocation, and posterior rim fractures occur from pos-
terior dislocation of the shoulder. Early surgery should
be performed for reduction of the fragment and inter-
nal fixation when larger in size and displaced. When
these are isolated fragments, this can be done by rotator cuff problems and is called an os acromiale. articular surface of the glenoid with displacement are
arthroscopic surgery. These growth abnormalities are shown in Plate 1-39. often treated by surgical means, particularly those that
Acromial fractures often result from trauma to the Fracture fragments can include multiple portions of are associated with anterior or posterior dislocation of
superior aspect of the shoulder by direct trauma. Non- the scapula body. Scapular body fractures or scapular the shoulder. These fracture fragments often will result
fused growth centers of the acromion can occur and neck fractures that are not displaced or only moderately in persistent instability of the shoulder. Displaced frac-
appear to be fractures but are not related to trauma. displaced are most often treated by nonoperative tures of the glenoid fossa can also result in significant
This entity is more commonly associated with chronic measures. Those fracture fragments that involve the post-traumatic arthritis.
32 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS