Types of Clavicle fracture in Human Body !

There is more than one accepted classification for clavicle fractures. 

how it brakes? 

Most clavicle fractures are caused by a fall or other direct trauma to the shoulder, usually with the clavicle bending and breaking over the fulcrum of the first rib. Falls on an outstretched hand, although commonly cited, account for a smaller percentage of clavicle fractures.  

1. Craig's classification For Clavicle fracture:

• Group I-fracture of the middle one third (most clavicular fractures are the group I fractures;
• Group II-fracture of the lateral or distal one third 

1. Type I-minimally displaced
2. Type II-displaced secondary to a fracture medial to the coracoclavicular ligament complex
3. Type III-fracture of the articular surface
4. Type IV-ligaments intact to the periosteum, with a displacement of the proximal fragment
5. Type V -comminuted

• Group III-fracture of the medial one third

1. Type I-minimally displaced
2. Type II-displaced
3. Type III-intraarticular
4. Type IV -epiphyseal separation
5. Type V -comminuted 

2. Fractures of the distal clavicle (lateral one third) are further subclassified into three types by Neer:

• Type I-lateral to the coracoclavicular ligament complex, and thus stable.
• Type II-medial to the coracoclavicular ligaments, leaving the distal clavicle and the acromioclavicular joint intact but separate from the underlying coracoclavicular ligament complex. These are associated with an increased risk of nonunion.
• Type III-involving the articular surface of the distal portion of the clavicle. These are usually associated with major ligamentous disruption. 

Treatment Goals

Orthopedic Objectives

Alignment: Achieve anteroposterior and lateral alignment of the fracture because the clavicle is a curvilinear bone.

Stability: Stability is achieved using external immobilization for most fractures or, less commonly, by open reduction and internal fixation for more difficult fractures. 

Rehabilitation Objectives For Physiotherapist

1. Restore and improve the range of motion of the shoulder.

2. Improve the Muscle Strength of the following muscles:

Sternocleidomastoid (neck rotation)
Pectoralis major (arm adduction)
Deltoid (arm abduction) 

3. Functional Goals

Improve and restore the function of the shoulder for activities of daily living and vocational and sports activities. 

This Rehabilitation can be as long as 10 to 12 weeks. and bone healing can take 6 yo 12 weeks to heal properly.

DAY ONE TO ONE WEEK

Precautions Shoulder is held in adduction and internal rotation. Elbow is maintained at 90 degrees of flexion.

Range of Motion No range of motion to the shoulder.

Muscle Strength No strengthening exercises to the shoulder.

Functional Activities The uninvolved extremity is used in self-care and personal hygiene.

Weight-bearing None. 

Two WEEKS 

Precautions Shoulder is held in adduction and internal rotation. Elbow is held at 90 degrees of flexion.

Range of Motion Gentle pendulum exercises to the shoulder in the sling as pain permits.

Muscle Strength No strengthening exercises to the shoulder. Start gentle isometric exercises to the deltoid.

Functional Activities The uninvolved extremity is used in self-care and persona hygiene.

Weight-bearing None

FOUR TO SIX WEEKS

Precautions Limit abduction.

Range of Motion At the end of 6 weeks, a gentle active range of motion to the shoulder is allowed. Abduction is limited to 80 degrees.

Muscle Strength Pendulum exercises are prescribed to the shoulder with gravity elimination. Start isometric exercises to the rotator cuff and deltoids.

Functional Activities The patient uses the affected extremity for some self-care and personal hygiene.

Weight-bearing None. 

SIX TO EIGHT WEEKS 

Precautions None. Avoid contact sports.

Range of Motion Active to an active-assistive range of motion in all planes.

Muscle Strength Resistive exercises to the shoulder girdle muscles.

Functional Activities The patient uses the involved extremity for personal hygiene, self-care, stabilization, and light activities.

Weight-bearing Gradual weight-bearing is allowed. 

EIGHT TO TWELVE WEEKS

 Precautions None.

Range of Motion Active, active-assistive range of motion to the shoulder. Abduction is encouraged.

Muscle Strength Isometric and isotonic exercises are prescribed to the shoulder girdle muscles. Resistive exercises are prescribed.

Functional Activities The involved extremity is used in self-care and functional activities.

Weight-bearing Full weight-bearing.