Scapular Fractures

Scapular Fractures

Fractures to the scapula are rare in athletics and require extreme forces.49 Because of the violent nature of scapular fractures, suspicion of associated thoracic injuries must be assumed until definitely ruled out. Proper immediate management of scapular fractures typically consists of immobilizing the injured extremity and activating EMS for comprehensive care. Prompt activation of EMS is prudent because extreme forces eliciting scapular fracture may be associated with life-threatening thoracic injuries. The athletic trainer can best manage scapular fractures by having the injured athlete sit upright for elevation, immobilizing the affected extremity in a sling and swathe, and carefully applying ice for pain control. Furthermore, athletic trainers must periodically monitor the injured athlete’s vital signs while awaiting EMS to recognize the potential onset of life-threatening injures such as pneumothorax.

Clavicle

Clavicular fractures are frequent injuries encountered in sports. Fractures to the clavicle usually result from a direct force to the bone or are secondary to a traumatic force imparted onto the lateral aspect of the shoulder complex.

Because the clavicle is very superficial, fractures are usually obvious. However, its superficial orientation also warrants appreciation because improperly managed injuries are in potential danger of exacerbation into an open fracture.

Clavicular fractures may present with or without obvious anatomical deformity in addition to focal bone pain. Discomfort typically intensifies considerably with passive and active excursion of the shoulder complex, especially GHJ horizontal adduction.Moreover, fractures of the clavicle are usually classified by dividing the respective anatomy into thirds. Fractures to the intermediate and lateral thirds of the clavicle are most prevalent. Regardless of displacement, these fractures are best treated with a sling and swathe, careful application of ice for pain control, and urgent referral to an orthopedic specialist for consultation. Traditionally, figure-eight bandages were indicated but they proved fairly cumbersome and yield a higher incidence of complications with less than optimal functional outcomes.

The most severe yet least common type of clavicular fracture occurs at the medial third. This specific skeletal fracture carries significant potential for dire related injuries such as thoracic and neurovascular compromise.

Effective emergency medical care includes thoroughly monitoring the athlete’s vital signs and placing the injured extremity in a sling and swathe. It cannot be understated that this identifiable pathology necessitates immediate activation of EMS for ruling out associated life-threatening

injuries and ensuring comprehensive care. Acute complications are not typical, yet in certain circumstances pneumothorax or hemothorax may result and lesions to the brachial plexus or subclavian vasculature are possible. As such, athletic trainers must perform a complete adjunct

examination of pulmonary and neurovascular functions during routine management of clavicular fractures.

 

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