Shoulder fracture (clavicle, humerus, shoulder blade) Flashcards
What nerves may be damaged in clavicle fractures or their repairs?
Clavicle fractures and/or shoulder surgeries can injure the lateral, intermediary or medial branches of the supraclavicular nerve
What is the result of supraclavicular nerve injury?
Numbness over the clavicle
How do you test the nerves of the arm?
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
What causes winging of the scapula?
Long thoracic nerve injury - C5/6/7 (going up to heaven)
When do the growth plates of the clavicle fuse?
25yrs
Who is most affected by clavicle fractures?
Children > adults
Most common fracture of childhood
What is the mechanism of injurt in clavicle fractures?
FOOSH
High energy mechanisms
Which parts of the clavicle are most commonly fractured?
Middle third - 69%
Distal third - 28%
Proximal third - 3%
What classification is used for clavicle fractures?
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.
How does clavicle fracture present?
- 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
How does a co-existing scapular and clavicle fracture present?
‘floating shoulder’
What is the management of clavicle fractures?
- 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)
What are the acute and late complications of clavicle fractures?
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).
What is the mechanism of injury in humeral shaft fractures?
FOOSH
Direct blow to upper arm
What are the complications of humeral shaft fractures?
Radial nerve injury
Brachial artery rupture
What is the management of humeral shaft fractures?
- 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
