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.

Malunion and not non-union is the common complications of fracture clavicle.

In a syndrome called cleidocranial dysostosis, absence of part of the clavicles accompanies a broad skull, and facial and dental anomalies.

Note that you could also have answered this question by noting that of the bones listed, only the clavicles form by intramembranous ossification.

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 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 radiologically age determination.

* Way of remembering : By radiological examination of wrist we can determine age of 16, 17, 18, 19; From shoulder 17, 18, 19, 20 & from crest of ilium examination 18, 19, 20, 21. These all are 4 continuous numbers starting from 16 from wrist, 17 for shoulder & 18 for crest of ilium. Also remember that P^t two years are for girls & last two for boys. Radiological examination of 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).

A i.e. No treatment required for fracture but rest

A i.e. Most common complication is malunion

A i.e. Clavicle

B i.e. Malunion

C i.e. Figure of 8 bandage

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

C i.e. Clavicle

B i.e. Figure of 8 bandage

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., No medullary cavity

Peculiar features of clavicle

• First bone to ossify in the body.
• Only long bone which ossify from two primary and one secondary centre.
• Only long bone in the body lying horizontal.
• Only long bone which ossify from a membrane (Intramembranous ossification).
• Only link between the appendicular and the axial skeleton.
• The most common bone to be fractured in children and during birth.
• Only long bone subcutaneous throughout.
• It has no medullary cavity.
• The most common site for fracture of clavicle is the junction of the middle third and outer third (i.e. junction of medial 2/3^rd and lateral 1/3^rd).

Ans:C.)No medullary cavity.

• Peculiarities of Clavicle:

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

Ans. is ‘c’ i.e., Clavicle fracture

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

• Essentials of orthopaedics Fracture neck femur, IT fracture and colle’s fracture are more common in old age and with trivial injury. o Important fractures caused by violent trauma are :- Clavicle, fracture shaft femur, subtrochanteric femur fracture, fracture shaft tibia, cervical and lumbar spine fractures.