Shoulder fracture (clavicle, humerus, shoulder blade) Flashcards

1
Q

What nerves may be damaged in clavicle fractures or their repairs?

A

Clavicle fractures and/or shoulder surgeries can injure the lateral, intermediary or medial branches of the supraclavicular nerve

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2
Q

What is the result of supraclavicular nerve injury?

A

Numbness over the clavicle

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3
Q

How do you test the nerves of the arm?

A

Axillary nerve - motor supply to the deltoid and teres minor, sensory supply to regimental patch area

Ulnar nerve - motor supply to the hypothenar eminence, FDP or ring and little finger and lumbricals (test with cross-fingers or abduct fingers against resistance); sensory supply to medial 1.5 digits dorsal and palmar sides

Radial nerve - motor to wrist extension and thumbs up (IP joint extension against resistance), sensation over the anatomical snuffbox,

Median nerve - recurrent motor branch: palmar abduction of thumb; anterior interosseous branch: flexion of thumb IP and index DIP (“A-OK sign”); sensory to lateral 3.5 fingers palmar mostly

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4
Q

What causes winging of the scapula?

A

Long thoracic nerve injury - C5/6/7 (going up to heaven)

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5
Q

When do the growth plates of the clavicle fuse?

A

25yrs

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6
Q

Who is most affected by clavicle fractures?

A

Children > adults

Most common fracture of childhood

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7
Q

What is the mechanism of injurt in clavicle fractures?

A

FOOSH

High energy mechanisms

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8
Q

Which parts of the clavicle are most commonly fractured?

A

Middle third - 69%

Distal third - 28%

Proximal third - 3%

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9
Q

What classification is used for clavicle fractures?

A

Neer

Group I: Fractures of the middle third or midshaft fractures (the most common site),

Group II: Fractures of the distal or lateral third. A common site for non-union.

Group III: Fractures of the proximal or medial third.

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10
Q

How does clavicle fracture present?

A
  • Cradling the injured arm
  • Snapping or cracking on injury
  • Shoulder shortening
  • Swelling/ecchymosis/tenderness
  • Crepitus

Other:

  • Pneumothorax signs/symptoms
  • Neurovascular compromise - subclavian artery injury or brachial plexus injury
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11
Q

How does a co-existing scapular and clavicle fracture present?

A

‘floating shoulder’

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12
Q

What is the management of clavicle fractures?

A
  • ABC and full examination including neurovascular status
  • Immobilise arm in sling
  • Refer for XR
  • Analgesia - opiates if pain is severe
  • Conservative management if
    • undisplaced
    • group I or III
  • Surgical management
    • goup II displaced fractures (coracoclavicular ligament ruptured)
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13
Q

What are the acute and late complications of clavicle fractures?

A

Acute

  • Pneumothorax.
  • Haemothorax.
  • Brachial plexus injury.
  • Blood vessel injury (including subclavian vessels, internal jugular vein and axillary artery).

Late

  • Non-union and malunion (no radiographic healing at 4-6 months)
  • Deformity due to excessive callus formation during fracture healing.
  • Thoracic outlet syndrome.
  • Brachial plexus compression due to callus formation.
  • Arthritis (more common in fractures involving the articular surface - group 2, type III).
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14
Q

What is the mechanism of injury in humeral shaft fractures?

A

FOOSH

Direct blow to upper arm

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15
Q

What are the complications of humeral shaft fractures?

A

Radial nerve injury

Brachial artery rupture

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16
Q

What is the management of humeral shaft fractures?

A
  • Immobilisation for 8-12 weeks
    • Collar and cuff sling
    • Gutter splints surrounding the fracture
    • Humeral brace - polythene encircling splint fastened by Velcro strips
  • Surgery
    • Plate fixation/IM nail - lower non-union rates than with screws
17
Q

Which parts of the scapula are most commonly fractured?

A

scapular body/spine = 45-50%

glenoid = 35%

  • glenoid neck = 25%
  • glenoid fossa/rim = 10%
  • often associated with impaction of humeral head into glenoid

acromion = 8%

coracoid = 7%

https://www.orthobullets.com/trauma/1013/scapula-fractures

18
Q

What is the primary method of nonoperative management for scapula fractures?

A

sling for 2-3 weeks, followed by early motion - 90% of scapula fractures are managed this way