UPPER EXTREMITY• CLAVICLE FRACTURES

UPPER EXTREMITY
• CLAVICLE FRACTURES
Key facts
1. Clavicle fractures are very common in children and adults but fortunately heal rapidly and respom well to conservative management. Clavicle fractures are usually a result of a fall onto the shoulder or motor vehicle collision
2. Clavicle fractures are classified primarily by location and secondarily by the amount of deformity. The clavicle is a somewhat S-shaped bone with a flat cross section laterally and a round cross section medially. This changing cross section influences the location of fractures. Middle third (group I) fractures account for about 80% of the total. Lateral third (group II) account for about 15 % and medial third (group III) only 5%.
3. Comminution is not uncommon in all three types. Displacement of the fragments is largely a function of muscle and ligament attachments. Gravity tends to pull the shoulder joint and distal clavicle fragments down, while the muscles tend to hold medial fragments up.
4. In distal third fractures (group II), the integrity of the coracoclavicular ligaments influences the type and severity of displacement. Intact ligaments provide fracture stability
5. Clavicle fracture are usually diagnosed clinically, and the main fuction of radiographs is to assess the nature and severity of the fracture. Two projections are usually used. One is a straight AP view and the other is AP with the beam directed 20 to 40 degrees cephaled
6. Associated subluxations or dislocations of the acromioclavicular and sternoclavicular joints are often present.
7. Clavicle fractures are most commonly isolated injuries. Associated injuries to the lung apex, subclavian vessels, brachial plexus, and first rib are infrequent.

• ACROMIOCLAVICULAR JOINT DISLOCATION
Key facts
1. The acromioclavicular joints is supported by a thin fibrous capsule and by discrete acromioclavicular ligaments situated anteriorly, posteriorly, superiorly, and inferiorly. Further support for this joint is provided by the coracoclavicular ligaments.
2. The exact relationship between the acromion and clavicle varies, with orientation of the joint being anywhere from parallel to the glenoid to 50 degrees of obliquity. The clavicle can lie somewhat superior to the acromion, a normal variant that should not be mistaken for traumatic dissociation
3. Acromioclavicular joint injuries are classified into six type, according to the associated ligament injuries :
- Type I is a simple sprain of the acromioclavicular ligaments (without frank rupture) and radiographically shows no joint displacement.
- Type II has disrupted acromioclavicular ligaments, allowing some displacement of the joint, but the the coracoclavicular ligaments are intact, preventing complete dissociation. There may be widening of the acromioclavicular joint, but minimal if any elevation of the distal clavicle.
- Type III has disruption of both the acromioclavicular and coracoclavicular ligaments with complete dissociation of the scapula and clavicle. Identified by elevation of the distal clavicle with respect to the acromion.
- Types IV (posterior clavicle dislocation), V (marked superior clavicle separation with muscular puncture) and VI (inferior clavicle dislocation) are all rare.
Type I and II injuries are usually managed conservatively. Type III injuries are usually repaired surgically.
4. The acromioclavicular joint is best seen on modified AP views of the shoulder with the beam angled 10 to 15 degrees cephaled. The opposite joint should be imaged for comparison, to allow for the large variations in normal anatomy. The radiographs should be obtained with the patient sitting or standing and the arms hanging loosely at the sides. A second similar examination should then be performed with 10 to 15 pound weights in each hand, to evaluate instability.
5. In some Type II injuries the acromioclavicular displacement can actually decrease with weights as the patient contracts the shoulder muscles in reaction to the load. This still represents joint laxity-any motion with weight bearing should be considered abnormal.

• SHOULDER JOINT DISLOCATION
Key facts
1. Dislocation of the shoulder joint accountfor more than half of all major joint dislocation
2. Shoulder dislocation are classified according to the position of the humeral head , relative to the glenoid labrum. The positions in which th head can reside are anterior, posterior inferior, and superior.
3. Anterior dislocations account for more than 90% of the total and posterior dislocations account for most of the remainder. Inferior dislocations are very uncommon and superior dislocations are rare. The rarest variant is intrathoracic dislocation, with the humeral head protruding through the chest wall.
4. In anterior dislocations, the humeral head is displaced not only anteriorly but most commonly also medially and inferiorly to a subcoracoid position (fig 4.3). the resultant deformity is readily visible both clinically and radiograp

Hasil (Bahasa Indonesia) 1:

UPPER EXTREMITY• CLAVICLE FRACTURESKey facts1. Clavicle fractures are very common in children and adults but fortunately heal rapidly and respom well to conservative management. Clavicle fractures are usually a result of a fall onto the shoulder or motor vehicle collision2. Clavicle fractures are classified primarily by location and secondarily by the amount of deformity. The clavicle is a somewhat S-shaped bone with a flat cross section laterally and a round cross section medially. This changing cross section influences the location of fractures. Middle third (group I) fractures account for about 80% of the total. Lateral third (group II) account for about 15 % and medial third (group III) only 5%.3. Comminution is not uncommon in all three types. Displacement of the fragments is largely a function of muscle and ligament attachments. Gravity tends to pull the shoulder joint and distal clavicle fragments down, while the muscles tend to hold medial fragments up.4. In distal third fractures (group II), the integrity of the coracoclavicular ligaments influences the type and severity of displacement. Intact ligaments provide fracture stability5. Clavicle fracture are usually diagnosed clinically, and the main fuction of radiographs is to assess the nature and severity of the fracture. Two projections are usually used. One is a straight AP view and the other is AP with the beam directed 20 to 40 degrees cephaled6. Associated subluxations or dislocations of the acromioclavicular and sternoclavicular joints are often present.7. Clavicle fractures are most commonly isolated injuries. Associated injuries to the lung apex, subclavian vessels, brachial plexus, and first rib are infrequent.• ACROMIOCLAVICULAR JOINT DISLOCATIONKey facts1. The acromioclavicular joints is supported by a thin fibrous capsule and by discrete acromioclavicular ligaments situated anteriorly, posteriorly, superiorly, and inferiorly. Further support for this joint is provided by the coracoclavicular ligaments.2. The exact relationship between the acromion and clavicle varies, with orientation of the joint being anywhere from parallel to the glenoid to 50 degrees of obliquity. The clavicle can lie somewhat superior to the acromion, a normal variant that should not be mistaken for traumatic dissociation 3. Acromioclavicular joint injuries are classified into six type, according to the associated ligament injuries :- Type I is a simple sprain of the acromioclavicular ligaments (without frank rupture) and radiographically shows no joint displacement.- Type II has disrupted acromioclavicular ligaments, allowing some displacement of the joint, but the the coracoclavicular ligaments are intact, preventing complete dissociation. There may be widening of the acromioclavicular joint, but minimal if any elevation of the distal clavicle.- Type III has disruption of both the acromioclavicular and coracoclavicular ligaments with complete dissociation of the scapula and clavicle. Identified by elevation of the distal clavicle with respect to the acromion.- Types IV (posterior clavicle dislocation), V (marked superior clavicle separation with muscular puncture) and VI (inferior clavicle dislocation) are all rare.Type I and II injuries are usually managed conservatively. Type III injuries are usually repaired surgically.4. The acromioclavicular joint is best seen on modified AP views of the shoulder with the beam angled 10 to 15 degrees cephaled. The opposite joint should be imaged for comparison, to allow for the large variations in normal anatomy. The radiographs should be obtained with the patient sitting or standing and the arms hanging loosely at the sides. A second similar examination should then be performed with 10 to 15 pound weights in each hand, to evaluate instability.5. In some Type II injuries the acromioclavicular displacement can actually decrease with weights as the patient contracts the shoulder muscles in reaction to the load. This still represents joint laxity-any motion with weight bearing should be considered abnormal.• SHOULDER JOINT DISLOCATIONKey facts1. Dislocation of the shoulder joint accountfor more than half of all major joint dislocation2. Shoulder dislocation are classified according to the position of the humeral head , relative to the glenoid labrum. The positions in which th head can reside are anterior, posterior inferior, and superior.3. anterior dislokasi account untuk lebih dari 90% dari total dan posterior dislokasi akun untuk sebagian besar sisanya. Dislokasi rendah sangat biasa dan unggul dislokasi jarang. Varian langka adalah dislokasi intrathoracic, dengan kepala humerus menonjol melalui dinding dada.4. dalam anterior dislokasi, kepala humerus dipindahkan tidak hanya anterior tetapi paling sering juga medial dan inferior ke posisi subcoracoid (ara 4.3). kelainan resultan mudah terlihat baik klinis dan radiograp