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