– 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 –
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A triangular sling to support the affected limb.
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A figure of eight bandage may be applied with displaced fracture. Duration=3 weeks.
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ORIF; When the fracture is associated with the neurovascular deficit.
Complications –
Early complications:-
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Injury to the subclavian vessels or brachial plexus.
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Malunion.
Late complications:-
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Shoulder stiffness.
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Non-union.
Occupational Therapy Goals-
– Restore and improve the ROM of the shoulder.
– Improve the strength of
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Sternocleidomastoid muscle.
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Pectoralis major muscle.
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Deltoid muscle.
Occupational Therapy Management – (10-12 weeks)
Day of injury to week one-
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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.
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No ROM or strengthening exercise is prescribed for the shoulder.
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The patient is advised to initially sleep on a reclining chair and to roll over the unaffected side to come to the upright position.
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Avoid weight-bearing of the affected extremity.
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Full AROM is encouraged for the wrist, hand and digits.
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Gentle isometric exercises for the elbow and wrist are begun 3 to 4 days after the fracture, once the pain subsides.
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Use of uninvolved extremity and self-care and personal hygiene.
2 to 4 weeks-
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Continue ROM of elbow, wrist, hand and digits.
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No weight-bearing on the affected extremity.
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Gentle pendulum exercises for the shoulder within a pain-free range.
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Continue isometric exercises of the elbow and wrist and begin isotonic exercises for the digits.
4 to 6 weeks-
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No weight bearing on the affected extremity.
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Gentle AROM of the shoulder.
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Abduction restricted to 80° and external rotation to avoid stress on the fracture site.
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Continue with elbow, wrist and digit ROM.
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Isometric exercises for the rotator cuff and deltoid.
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Pendulum exercises for the shoulder with gravity eliminated.
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Therapeutic putty to maintain the patient’s grip and grasp.
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Use of affected extremity for self-care and personal hygiene.
6 to 8 weeks-
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Full AROM to AAROM In all planes.
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Resistive strengthening of shoulder girdle muscles.
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Use of involved limb for personal hygiene, self-care and light work.
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Gradual weight-bearing is allowed when pushing off from a chair or bed or using a cane.
8 to 12 weeks-
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AROM, AAROM and PROM Exercises are prescribed.
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Abduction is encouraged.
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PRE to the shoulder is continued.
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Continue with isometric and isotonic exercises for the shoulder girdle muscles, pectoralis major and sternocleidomastoid.
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Full weight-bearing is allowed.
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Normal use of the affected limb.
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Avoid contact sports for 2-3 months.
