Sneak peek in handbook of family medicine vol 1

Dear friends,
 Here I am sharing sneak peek of my next book.This is just a sample representation and not the actual image.Hope it will inspire you for booking starting from 20 June.good day.

                          Fracture of clavicle

Ø  Fracture of clavicle is very common type of fracture due to fall on outstretched hand or road traffic accidents.

Ø  It can also occur due to violence or direct fall on shoulder joint.

Types:

1.       Junction of middle and outer third of clavicle.

2.       Outer third of clavicle.

3.       Inner third of clavicle.

4.       In children, green stick type.

Mechanism:

Ø  If it occurs with greater force on clavicle or direct violence there can be separation of bone into two pieces.

Ø  Medial end get pull due to underlying sternomastoid muscle & becomes elevated.

Ø  Lateral fragment sags below & forward due to weight of the arm.

Ø  It gets displaced medially by pectoralis major & forward due to pull with forward rotation of scapula.

Ø  Rare cases both bones can get separated and are not in contact.

Ø  If outer third is involved, there is minimal displacement of bony ends as both fragments are attached to scapula by coracoclavicular ligament.

Clinical features:

Ø  Patient often enters clinic supporting elbow of the injured side with other hand and bending slightly towards injured side.

Ø  A careful documentation of history is important to understand mechanism and force which cause injury.

Ø  Patient complaints of difficulty in using arm of injured side.

Ø  They also complaint of pain around shoulder and difficulty is raising arm.

Ø  There is distinct tenderness at site of fracture be it in middle third or lateral third or medial third.

Ø  X-ray gives clear idea a about type of fracture.

Treatment:

Ø  In children with green stick fracture, clavicular collar cuff or broad arm sling is used to keep hand elevated and relive the pain.

Ø  In adults, middle third clavicle type of fracture with displacement, reduction is required by pulling patients shoulder firmly backwards to align bone fragments.

Ø  Displaced fragments should be kept aligned well if not maintained mal union can occur.

Ø  Few methods can be used to keep them in alignment like Figure of 8 bandages, clavicular ring.

Ø  If fracture is at lateral end & fragments are not displaced, a simple  clavicular collar with cuff or broad arm sling (triangular sling) can be used for 3 weeks .

Ø  If fragments are displaced, they may require surgical fixation or plaster to keep in alignment.

Ø  Any type of clavicular fracture requires periodic inspection.

Ø  If bandages are used they require tightening once a day for first week and every 2-3 days for next 2-3 weeks.

Ø  If slings are used they should be changed after 2 weeks.

Ø  A clavicular collar and cuff or broad arm sling is use to support shoulder.

Ø  As soon as pain relives patient should be encouraged to move hand.

Ø  Elbow, wrist, fingers must get exercise from beginning.

Ø  Once pain subsides, patient can do gradual shoulder movements.

Ø  Sling can be stopped once pain subsides and fracture aligns.

Ø  Surgical open reduction required when there is neurovascular deficit or cosmetic deformity with demand of correction by patient.

Ø  It can be fixed by using plates internally.

Complication:

Ø  Mal-union.

Ø  Nonunion.

Ø  Subclavian vessel injury or brachial plexus injury.

Ø  Stiffness of shoulder.