CLAVICLE

Ans:A.)Shoulder dislocation .

Velpeau & Sling and swathe bandage are used for shoulder dislocation, proximal humerus fracture and humeral fracture.

Sling and swathe splint —The sling supports the weight of the arm and the swathe holds the arm against the chest to minimize shoulder motion.

Velpeau bandage — The Velpeau bandage is another splint that is used for shoulder and humeral injuries. It is similar to the sling and swathe splint, except that the hand is held higher and the forearm lies against the chest. The decision to use the sling and swathe splint or the Velpeau bandage is based upon the patient’s comfort.

Splints & Indication :

Upper extremity splints

• Figure-of-eight splint -medial two-thirds of the clavicle.
• Sling and swathe – Shoulder injuries, humeral injuries
• Velpeau bandage – Shoulder injuries, humeral injuries
• Sugar tong splints

– Proximal sugar tong splint – Humeral fractures

– Distal sugar tong splint – Wrist fractures, distal forearm.fractures – Double sugar tong splint – Elbow fractures, forearm fractures

– Reverse sugar tong splint – Distal forearm fractures, Colles fracture

• Posterior arm splint or Long arm splint – Stable injuries of the elbow and forearm
• Colles splint – Distal forearm and wrist .fractures
• Dorsal or volar splint – Wrist fractures or injuries, fractures of 2nd to 5th metacarpals, carpal tunnel syndrome, soft tissue injuries of the hand
• Gutter splint – Phalangeal and metacarpal fractures
• Thumb Spica splint – Scaphoid fractures, extra-articular fractures of the thumb metacarpal, ulnar collateral ligament injuries
• Volar finger splint – Fractures of distal phalanges and interphalangeal joints
• Bulky hand compression dressing – Closed hand fractures

Lower extremity splints

• Knee splint – Knee injuries, proximal fractures of the tibia and .fibula
• Jones compression – Knee and calf injuries
• Posterior leg or ankle splint

– Distal leg, ankle, tarsal, and metatarsal fractures

– Reduced dislocations, severe sprains

• Stirrup splint -Ankle.fractures
• Bulky foot compression dressing

– Calcaneal fractures

– Foot injuries

• Buddy taping – Phalangeal_.fractures of the toes

The epiphyses of the elbow joint fuses by 15 – 17 years in males.
The epiphysis of the shoulder joint fuses by 18 – 19 years of age.
If the inner end of the clavicle has fused he is at least 21 years of age or more.

Clavicle
The most common complication of clavicle fractures is malunion.
Development

• The collarbone is the first bone to begin the process of ossification (laying down of minerals onto a preformed matrix) during development of the embryo, during the fifth and sixth weeks of gestation.
• However, it is one of the last bones to finish ossification at about 21–25 years of age. Its lateral end is formed by intramembranous ossification while medially it is formed by endochondral ossification.

Complications

• The most common complication of clavicle fractures is malunion.
• Nonunion is the failure of the fracture to heal in 4 to 6 months. In middle-third clavicle fractures, the nonunion rate for all fractures treated nonoperatively is 6%, increasing to 15% in displaced fractures. Nonunion rates for distal third clavicle fractures range from 28% to 44%.
• Proximal-third clavicle fracture complications include nonunion and posttraumatic arthritis.

Treatment / Management

• Supportive treatment involves the placement of a sling or sling and swathe, while reductive treatment includes the use of a figure-of-eight brace
• Surgical fixation is achieved with open reduction with plate fixation or intramedullary fixation

The description suggests a congenital disorder involving membranous ossification, most likely cleidocranial dysostosis (also called cleidocranial dysplasia).

➤ Membranous Bone Formation:

• Membranous bones develop directly from mesenchymal tissue without a cartilage precursor.

• These include:

  • Flat bones of the skull (frontal, parietal, etc.)

  • Facial bones

  • Part of the mandible

  • Clavicles

➤ Clavicles – Key Association:

• The clavicle is one of the first bones to ossify and forms via both intramembranous and endochondral ossification.

• In cleidocranial dysostosis, clavicles may be partially or completely absent, allowing the patient to bring shoulders together in front of the chest — a classical finding.

A shoulder separation is an injury to the acromioclavicular joint.
A first-degree separation involves stretching the ligaments, but maintenance of the joint.
A second-degree separation involves tearing of the joint capsule and coracoclavicular ligament, but still maintains continuity.
A third-degree separation involves total disruption of the joint and the coracoclavicular ligament.

• Since the patient has a third-degree shoulder separation, you know he must have torn his coracoclavicular ligament. The coracoacromial ligament contributes to the stability of the acromioclavicular joint, but damaging this ligament is not the hallmark of a third-degree shoulder separation.
• The costoclavicular ligament connects the first rib to the clavicle. The superior glenohumeral ligament contributes to the stability of the shoulder joint, but not to the stability of the acromioclavicular joint. The transverse humeral ligament holds the tendon of the long head of the biceps in place in the intertubercular groove.

Ans:B.)Clavicle.
Assessment of Bone Age:
 

D i.e. Iliac crest & clavicle
The following data is used for radiological age determination.

* Way of remembering: By radiological examination of the wrist, we can determine the age of 16, 17, 18, 19; From the shoulder 17, 18, 19, 20 & from the crest of the ilium examination 18, 19, 20, 21. These are all 4 continuous numbers starting from 16 from the wrist, 17 for the shoulder & 18 for the crest of the ilium. Also remember that P^t two years are for girls & last two for boys. Radiological examination of the elbow is done for age determination before this, i.e., 13 – 16 yrs. & R.E. of Ischial tuberosity & Clavicle inner end is done for 21, 22, 23, 24 age group (I^st 2 years for girls & last 2 years for boys).

Correct answer: A

While many clavicle fractures are treated conservatively, they do require proper management, including:

• Immobilization using a figure-of-eight bandage or sling

• Analgesics for pain

• Physical therapy after a few weeks

The clavicle is the most commonly fractured bone.
The collarbone is the first bone to begin the process of ossification (laying down of minerals onto a preformed matrix) during the development of the embryo, during the fifth and sixth weeks of gestation.
Clavicle fractures are typically treated by putting the arm in a sling for one or two weeks. Pain medication such as paracetamol (acetaminophen) may be useful

Option B – Correct:

• The most common site of clavicle fracture is at the junction of the medial 1/3rd and lateral 2/3rd, which is also considered part of the middle third.

• This site is structurally narrow and lacks strong muscular support.

Ans.A. Clavicle
Clavicle is the most common bone to be fractured in children and during birth.

• The clavicle is an ‘S-shaped’ bone that forms the only bony connection between the upper extremity and the axial skeleton.
• Due to its anatomical location, it lies over and creates a protective barrier for the brachial plexus and the subclavian vessels of the upper extremity.
• The clavicle is one of the most common fractured bones in children. 
• It is the most common perinatal fracture associated with birth trauma.  
• Half of all pediatric clavicle fractures occur under the age of seven years.

Correct Answer B i.e. Malunion

➤ Malunion – Most Common Complication

• Malunion occurs when the fractured bone heals in a misaligned position.

• In clavicle fractures, especially those treated conservatively, malunion is common due to displacement of fragments — the medial fragment is pulled upward by the sternocleidomastoid, while the lateral fragment is pulled downward by the weight of the limb.

• Fortunately, this malunion is usually cosmetic and not functionally significant, especially in children and adolescents.

 
In fractures of the clavicle, serious complications are rare.
Brachial plexus injury or injury to the subclavian vessels can occur at the time of presentation or during the healing and callus formation of the clavicle.
Excessive callus formation can lead to compression of the brachial plexus, resulting in peripheral neuropathy.
The most common complication of clavicle fractures is malunion, or when the clavicle fracture heals with angulation, shortening, or a poor cosmetic appearance. 
Non-union is the failure of the fracture to heal in 4 to 6 months.

C, i.e. Figure of 8 bandage

In a 14-month-old child, the treatment of a clavicle fracture should be:

• Simple, conservative, and non-invasive, because:

  • Clavicle fractures in infants and toddlers typically heal very well.

  • The remodeling capacity of bone at this age is excellent.

  • Most fractures are greenstick or minimally displaced.

B i.e. Junction of medial 2/3 & lateral 1/3rd

• Medial 2/3rd of clavicle is cylindrical & convex anteriorly.
• Lateral 1/3rd is flat & concave anteriorly.
• Due to change in the shape curvature, the most common site of fracture of clavicle is junction of medial 2/3 rd (middle 1/3rd) & lateral 1/3rd.

C, i.e. Clavicle

Clavicle Fracture – Most Common in Childhood:

• The clavicle is the most commonly fractured bone in children, especially in the neonatal period and early childhood.

• It is often injured due to:

  • Falls (on outstretched hand or directly on the shoulder)

  • Birth trauma (especially large babies or difficult deliveries)

• The clavicle is subcutaneous, curved, and the first bone to ossify, making it structurally vulnerable.

• During falls, force transmission from the upper limb to the clavicle makes it a common site of injury

B i.e. Figure of 8 bandage
Treatment for a broken collarbone usually requires a sling or figure-of-eight splint to keep the area immobile for several weeks.

➤ Fracture of Clavicle in an Infant:

• In infants and neonates, clavicle fractures:

  • They are usually the result of birth trauma or minor falls

  • They are minimally displaced and heal rapidly

  • Has excellent remodeling potential due to ongoing bone growth

➤ Best Treatment:

• Cuff and sling, or even pinning the sleeve to the shirt, is sufficient in infants.

• The goal is to provide comfort and minimal immobilization, not rigid fixation.

• Healing typically occurs in 10–14 days with minimal risk of complications.

Clavicle is generally said to have no medullary cavity, but this is not always true
Peculiarities of Clavicle:

• It has no medullary cavity
• It is the first bone to ossify in the fetus (5th-6th week)
• It is the only long bone having 2 primary centers of ossification (others have only 1)
• It is the only long bone that ossifies in membrane and not in cartilage
• It is the only long bone lying horizontally
• It is the most common fractured long bone in the body
• It is subcutaneous throughout

Ans. is ‘c’ i.e., Clavicle fracture

“Fractures of the first two or three ribs and of the clavicle indicate a violent trauma since they are thicker and well protected by the thoracic muscle.” 

Fracture neck femur, IT fracture, and Colles‘ fracture are more common in old age and with trivial injury.

Important fractures caused by violent trauma are:- Clavicle, fracture shaft femur, subtrochanteric femur fracture, fracture shaft tibia, cervical and lumbar spine fractures.