Chest and shoulder girdle
1. Fractures and dislocations of the clavicle
Clinical and radiological picture.
The patient holds the forearm and elbow of the injured limb with his healthy hand, pressing it to the body. Active and passive movements in the shoulder joint cause pain in the fracture area, where the end of the central fragment is palpated and pathological mobility and crepitus of the fragments are determined.
Signs:
- Local pain,
- Swelling,
- Hemorrhage and deformity,
- The supraclavicular fossa is smoothed,
- The shoulder is lowered and displaced anteriorly,
- The shoulder girdle is shortened.
2. Indications for conservative and surgical treatment of fractures and dislocations of the clavicle.
In most cases, clavicle fractures should be treated conservatively. Even if the displaced fragments grow together in the wrong position, over time, their partial resorption and reduction of deformation occur. The functional result, as a rule, is always good.
Immobilization options: on the left - with a kerchief bandage, on the right - with Delbe's rings (pulling the shoulders to the side and posteriorly, restoring the length of the clavicle)
Surgical treatment is indicated only in the following cases:
- 1) open fractures;
- 2) the threat of skin perforation;
- 3) damage to the neurovascular bundle;
- 4) concomitant fracture of the scapula neck;
- 5) pronounced displacement of fragments and the inability to keep them in the correct position after closed manual reduction.