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Questions and Answers
What is the primary mechanism of displacement of the proximal fracture fragment in a clavicular fracture?
What is the primary mechanism of displacement of the proximal fracture fragment in a clavicular fracture?
- Traction from the brachial plexus
- Gravity pulling the arm downwards
- Muscle spasms in the surrounding soft tissue
- Contraction of the sternomastoid muscle (correct)
What is the primary reason for assessing the distal neurovascular status in a patient with a clavicular fracture?
What is the primary reason for assessing the distal neurovascular status in a patient with a clavicular fracture?
- To assess the severity of the pain and tenderness
- To rule out any potential nerve or vascular damage (correct)
- To determine the appropriate surgical approach
- To evaluate the extent of bone damage
What is the purpose of obtaining a 30° caudal radiograph in a patient with a suspected clavicular fracture?
What is the purpose of obtaining a 30° caudal radiograph in a patient with a suspected clavicular fracture?
- To visualize the brachial plexus and subclavian vessels
- To assess the degree of shortening of the clavicle
- To evaluate the position and deformity of the fracture (correct)
- To rule out any potential soft tissue damage
Which of the following is a relative indication for surgical management of a clavicular fracture?
Which of the following is a relative indication for surgical management of a clavicular fracture?
What is the primary goal of conservative management of a clavicular fracture?
What is the primary goal of conservative management of a clavicular fracture?
What is the typical location of a clavicular fracture?
What is the typical location of a clavicular fracture?
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Study Notes
Clavicle Fractures
- Clavicle fractures commonly occur at the midpoint between the middle and distal thirds of the bone.
- The distal fracture fragment is displaced inferiorly due to gravity, while the sternomastoid muscle displaces the proximal fragment superiorly.
- Clavicle fractures are more common in young males and are often caused by direct falls onto the shoulder or outstretched hand (FOOSH).
Presentation
- Pain and tenderness are present in the shoulder and clavicular region.
- Visible protrusion along the clavicular line may be seen, and skin tenting or open fracture is possible.
- It is essential to assess the distal neurovascular status, including the brachial plexus, subclavian vessels, axillary nerve, and artery.
Investigations
- Clavicle AP radiograph and 30° caudal are used to assess position and deformity.
Management
- Conservative management: Immobilization using a sling or collar and cuff is usually sufficient.
- Surgical management: Open reduction and internal fixation (screws and plate, intramedullary rods) is indicated for:
- Displaced lateral fractures
- Shortening of the clavicle
- Open fractures
- Soft tissue (neurovascular) compromise
- Bilateral fractures
- Multiple trauma (e.g., flail chest and symptomatic nonunions)
Complications
- Postoperative complications:
- Infection
- Removal of metalwork
- Neurovascular injury
- Malunion (impinged shoulder abduction) or nonunion (~5-10%):
- Higher rate with lateral fractures
- Brachial plexus injury (high energy)
- Pneumothorax (high energy)
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