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SHOULDER GIRDLE
Clavicle Fracture (2-4% of all adult fractures)
- Class A - middle third (85%)
- Class B - lateral third (12%)
- Class C - medial third (3%)
- Check NV status as displaced fragments may damage brachial plexus
- Complications: non-union, malunion, deformity (tenting - can cause pressure necrosis)
- UC mx: Most heal without surgery. May consider plating but high NNT to avoid non-union. Arm sling, analgesia, figure of eight bandage for midshaft #
- Discuss with Ortho if:
- Open # or skin tenting
- NV compromise
- Lateral third (Class B) with displacement
- Any significant displacement (100% displaced or >2cm shortened)
- Follow up: Fracture clinic in 2 weeks + repeat XR
- Refer to Ortho if: non-union or ongoing symptoms at 6 weeks. Consider referral if no signs of healing at 2 weeks F/U
Acromio-Clavicular Joint Injuries
- Usual MOI - Fall on point of shoulder
- Exam - Prominence or palpable step over AC joint, Cross chess test or Sulcus sign positive
- Determine grade of injury: Rockwood Classification of AC Joint Injuries
- I: AC ligament sprain, CC ligament intact, no radiographic abnormalities
- II: AC ligament torn, CC ligament sprain, elevated clavicle but not beyond acromion border
- III: AC and CC ligament torn, elevated clavicle beyond acromion border
- IV: AC and CC ligament torn, posterior displacement of distal clavicle into trapezius
- V: AC and CC ligament torn, superior displacement of distal clavicle by more than 100% in the CC interspace
- VI: AC and CC ligament torn, inferolateral displacement in a subacromial or subcoracoid displacement
- Management: Rest, 3-7 day immobilisation, NSAID, PT.
- Refer to Ortho if:
- Grade 3 or 4 and above
- Grade 3 on dominant side, or requirement for overhead motions
- Skin tenting or cosmetic concerns
- Follow up: GP in 1-2 weeks, then fortnightly until able to return to normal activities
Shoulder Dislocation
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