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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