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MediClinic Cape Town


Netcare Blaauwberg Hospital


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Distal third of clavicle & scapula fractures

  • account for 15% of clavicle fractures

Type I

  • between the coracoclavicular and acromioclavicular ligaments
  • minimal displacement

Type II

  • # proximal to the ligaments
  • Type IIA
    • both conoid & trapezoid ligaments may be on the distal fragment
  • Type IIB
    • conoid ruptured, trapezoid ligament maintains attachment to the distal fragment
  • proximal fragment displaces up - pull of the sternocleidomastoid
  • downward pull of the arm on the distal fragment

Type III

  • # involves the articular surface of the acromioclavicular joint

Type IV

  • injury in a young patient
  • lateral end of the clavicle buttonholes through the periosteum
  • simulates an acromioclavicular dislocation

Type V

  • ligaments remain attached to a third inferior fragment and not to either the proximal or distal fragments

Assessment

  • AP and 10° cephalad radiographs

Treatment

Conservative treatment

  • used for types I and III
  • type Ill fractures may lead to degenerative changes in ACJ -> excision of the lateral end of the clavicle

ORIF

  • Type II and V fractures
  • intramedullary fixation, plating and costoclavicular screw
  • Type IV requires no intervention

Fractures of the scapula

  • occur infrequently
  • 3 to 5% of shoulder girdle injuries
  • may be associated injuries of the soft tissues, N/V structures & thoracic cage
    • may lead to delay in the diagnosis & management

Classification

  • Type I - Fractures of the body
  • Type II - Fractures of the apophysis (including the coracoid and acromion)
  • Type III - Fractures of the superolateral angle (including the neck and glenoid)

Ideberg classification for glenoid fractures

Type I

  • fracture of the glenoid rim
  • 1A - anterior
  • 1B - posterior

Type II

  • transverse fractures through the glenoid fossa
  • fracture line exits through the lateral scapular border

Type III

  • oblique fracture through the glenoid fossa exiting at the midsuperior border of the scapula

Type IV

  • horizontal, exiting through the medial border of the scapula

Type V

  • combination of the other fractures

Type VI

  • comminuted fracture