Right shoulder complex anterior view
Right shoulder complex posterior view
Clavicle fracture is associated with extreme pain with arm movement. The clavicle is subcutaneous and injury may cause local bruising with visual bump present. Most often clavicle fractures can be managed non operatively.
Group 1: Middle 1/3
Group 2: Lateral 1/3
Group 3: Medial 1/3
% incidence of clavicle fracture position
Classification of clavicle fractures according to Allman and Neer
Neer Classification | Fracture Characteristics | Proposed Management |
Type I | Extra-articular, lateral to CC ligaments | Non-operative |
Type II A | Medial to CC ligaments with intact ligaments, medial clavicle displacement with instability | Operative |
Type II B | 2 Part Fracture:
OR
|
Operative |
Type III | Intra-articular fracture lateral to CC ligaments with extension to ACJ with intact conoid & trapezoid ligaments, stable | Non-operative |
Type IV | Physeal fracture with intact CC ligaments, stable | Non-operative |
Type V | Communited fracture with intact CC ligaments, significant medial clavicle displacement, unstable | Operative |
CC: coracoclavicular, IM: intramedullary
Floating shoulder: Ipsilateral glenoid neck fracture and clavicle fracture
Approach: incision superior over clavicle. Medially are branches of suprascapular nerve
Anterior and posterior flaps created
Incise clavipectoral fascia
Laterally may have to release small area of pectoralis major and deltoid attachment
Approach: superior to clavicle
Reduce clavicle
Plate and screw fixation
Phases of rehabilitation:
Pendulum shoulder range of motion
Pendulum shoulder strength exercise
Shoulder strengthening with resistance band
Shoulder sling
Active wrist ROM after 2 weeks
Finger adduction strengthening
Finger abduction strengthening
Hand grip strengthening
Phases of rehabilitation:
Pendulum shoulder range of motion
Flexion with arm on table
Shoulder strengthening with resistance band after union