Clavicle Fracture

- Clavicle fracture is one of the commonest injuries seen at all ages.

- It is commonly fractured at the junction of its middle and lateral third.

- Mode of injury:- fall on an outstretched hand.

Classification:-

(A). Craig’s Classification:-

Group I:- Fracture of the middle one third.

Group II:- fracture of lateral/distal one third.

Type I:-Minimally displaced.

Type II:-Displaced secondary to a fractured medial of the coracoclavicular ligament complex.

Type III:-Fracture of the articular surface.

Type IV:- Ligaments intact to the periosteum with a displacement of the proximal fragment.

Type V:-Comminuted.

Group III:-Fracture of the medial one third.

Type I:-Minimally displaced.

Type II:-Displaced.

Type III:-Intraarticular.

Type IV:-Epiphyseal separation.

Type V:-Comminuted.

(B). Neer’s Classification of fracture of the distal clavicle –

Type I:-Lateral to the coracoclavicular ligament complex, stable.

Type II:-Medial to the coracoclavicular ligament, distal clavicle and AC joint are Intact but separate from the underlying coracoclavicular ligament complex. Increased risk of non-union.

Type III:-Involves the articular surface of the distal portion of the clavicle associated with major ligamentous disruption.

Treatment –

• A triangular sling to support the affected limb.

• A figure of eight bandage may be applied with displaced fracture. Duration=3 weeks.

• ORIF; When the fracture is associated with the neurovascular deficit.

Complications –

Early complications:-

• Injury to the subclavian vessels or brachial plexus.

• Malunion.

Late complications:-

• Shoulder stiffness.

• Non-union.

Occupational Therapy Goals-

- Restore and improve the ROM of the shoulder.

- Improve the strength of

• Sternocleidomastoid muscle.

• Pectoralis major muscle.

• Deltoid muscle.

Occupational Therapy Management – (10-12 weeks)

Day of injury to week one-

• The shoulder is held in a position of abduction and internal rotation and elbow in 90° flexion either by sling or figure of eight bandage.
  

• No ROM or strengthening exercise is prescribed for the shoulder.
  

• The patient is advised to initially sleep on a reclining chair and to roll over the unaffected side to come to the upright position.
  

• Avoid weight-bearing of the affected extremity.
  

• Full AROM is encouraged for the wrist, hand and digits.
  

• Gentle isometric exercises for the elbow and wrist are begun 3 to 4 days after the fracture, once the pain subsides.
  

• Use of uninvolved extremity and self-care and personal hygiene.

2 to 4 weeks-

• Continue ROM of elbow, wrist, hand and digits.
  

• No weight-bearing on the affected extremity.
  

• Gentle pendulum exercises for the shoulder within a pain-free range.
  

• Continue isometric exercises of the elbow and wrist and begin isotonic exercises for the digits.

4 to 6 weeks-

• No weight bearing on the affected extremity.
  

• Gentle AROM of the shoulder.
  

• Abduction restricted to 80° and external rotation to avoid stress on the fracture site.
  

• Continue with elbow, wrist and digit ROM.
  

• Isometric exercises for the rotator cuff and deltoid.
  

• Pendulum exercises for the shoulder with gravity eliminated.
  

• Therapeutic putty to maintain the patient’s grip and grasp.
  

• Use of affected extremity for self-care and personal hygiene.

6 to 8 weeks-

• Full AROM to AAROM In all planes.
  

• Resistive strengthening of shoulder girdle muscles.
  

• Use of involved limb for personal hygiene, self-care and light work.
  

• Gradual weight-bearing is allowed when pushing off from a chair or bed or using a cane.

8 to 12 weeks-

• AROM, AAROM and PROM Exercises are prescribed.
  

• Abduction is encouraged.
  

• PRE to the shoulder is continued.
  

• Continue with isometric and isotonic exercises for the shoulder girdle muscles, pectoralis major and sternocleidomastoid.
  

• Full weight-bearing is allowed.
  

• Normal use of the affected limb.
  

• Avoid contact sports for 2-3 months.