Ortho Case of the Week – Week 6 ANSWERS
- Midshaft (Type I) clavicle fracture with superior displacement of medial and lateral segments. Possible skin tenting based on pain film, correlate clinically. Fractures may be visualized on CXR, shoulder plain films or dedicated clavicle films.
- Multiple classification and subclassification systems exist for clavicle fractures, generally divided into middle third (type I), lateral third (type II) and medial third (type III) of clavicle. Type I consists of app. 80% of all clavicle fractures, and without complications (see below), treatment is generally simple sling and orthopedics follow up.
- Indications for ED Orthopedic consultation include all open fractures, displaced fractures with skin tenting, associated neurovascular injury, pediatric fractures with shortening of >2cm.
- The plain film reveals Grade III Acromioclavicular injury (shoulder separation). AC joint separation with superior displacement of the clavicle relative to the acromion and associated increased coracoclavicular distance.
- There are Six total types of AC joint separation injuries. When obtaining shoulder series plain films, consider obtaining contralateral/unaffected shoulder for comparison purposes. In general, treatment of types I-II usually consist of rest, ice, sling with return to activity as tolerated, type III-VI warrant orthopedic evaluation, can be usually be done as outpatient unless concern for neurovascular compromise. More information below.
Helpful links:
https://www.orthobullets.com/trauma/1011/midshaft-clavicle-fractures
https://www.orthobullets.com/shoulder-and-elbow/3047/acromioclavicular-joint-injury