Fractures of the distal clavicle are further divided into types I-III. 2000 Feb. 48(2):316-8. Fractures with 2 cm of shortening 4. Police Probe Pioneering Hip Surgeon Over Bone Hoarding Claims, Convicted Ex-Surgeon Pleads Guilty to New Fraud Charges, Experts Unravel the 'Mysteries of Wrist Motion', FDA Approves Implant as Alternative to ACL Reconstruction, Epidural Corticosteroid Injections for Sciatica. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. Proper closure of these incisions is imperative to decrease the risk of painful, prominent hardware. A Steinman pin is then placed in a retrograde fashion past the fracture site. Laborers may return to light lifting after 6 weeks and full duty at 12 weeks. [Medline]. Clavicle fracture is one of the most common birth injuries of a newborn. Low AK, Duckworth DG, Bokor DJ. For athletes, return to play depends on the location and severity of the clavicle fracture, the degree of clinical and radiographic healing, and the sport played. Such treatment can be divided into the following 2 categories: Simple support of the extremity - As in a sling or a sling and swath, Reduction and immobilization - Typically with figure-of-eight brace. Clavicular fractures in adults. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. [Medline]. Management of acute clavicle fractures. Acad Emerg Med. Stiffness is usually not a problem after nonoperative treatment of clavicle fractures. 2007 Apr. Clavicle Fractures 2. Management of acute clavicle fractures. 172:1006-1011. [35] These patients subsequently underwent open reduction and internal fixation with subsequent union of the fracture. Springer, London 2010. p.717-30. This procedure was performed on 11 acute distal clavicle fractures, all of which united with full range of motion. Housner JA, Kuhn JE. Regardless of the exact technique used, the general principles of fracture reduction and fixation and stabilization of the coracoclavicular interval apply. J Trauma. Overall, however, patients in both groups were satisfied with their results, although 35% of the surgical group had some adverse events during their recovery, most of which were minor. The goals of treatment are to restore normal anatomy, limit pain, and promote a quick return to activity or play. T1 - Management of clavicle fractures. All of the patients subsequently developed bony union of the fracture site with full range of motion. 25(5):272-8. Current management of medial clavicle fractures remains nonoperative, including with ice, analgesics, and a sling for support, and the treatment results have been consistently good. Given the excellent results obtained with nonoperative treatment of uncomplicated midclavicular fractures, such therapy, using a figure-of-eight brace or regular support sling, is recommended. J Trauma. Demirhan M, Bilsel K, Atalar AC, Bozdag E, Sunbuloglu E, Kale A. Biomechanical comparison of fixation techniques in midshaft clavicular fractures. The incision is carried down sharply to the clavicle without stripping the periosteum. Mueller M, Burger C, Florczyk A, Striepens N, Rangger C. Elastic stable intramedullary nailing of midclavicular fractures in adults: 32 patients followed for 1-5 years. Treatment of clavicle fractures: current concepts review. StatPearls [Internet]. [Full Text]. To provide feedback, please email. Fatal subclavian artery transection from isolated clavicle fracture. 2011 Nov. 27(11):1038-41. Clin Orthop Relat Res. Again, cancellous bone grafting is suggested in fractures with comminution and/or bone loss. [Medline]. Type I fracture of the distal clavicle (group II). Fractures of the clavicle. Repeat x-rays are usually not required. Jeray KJ. Around and lateral to coracoclavicular ligaments, Defined by shortening/comminution/angulation. 2009 Apr 15. Many techniques of surgical fixation of distal clavicle fractures have been described in the literature. Complete fracture displacement[4] 2. J Shoulder Elbow Surg. Wick M, Müller EJ, Kollig E, Muhr G. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. 2000 Feb. 67(1):32-4. Anteroposterior view of middle third clavicle fracture illustrating a relatively typical fracture pattern. Careful airway protection and neurovascular assessment is required. Additionally, functional outcomes were improved at all time points measured in the operative group. These patients underwent fixation of the nonunion with a lag screw, iliac crest bone grafting, and stabilization with a Dacron sling. Ann Emerg Med. Formaini N, Taylor BC, Backes J, Bramwell TJ. 3. 2008 Jul 22. Immobilization should continue until repeat radiographs show callus formation and healing across the fracture site. Reduction of the middle third is almost never required. For clavicle fractures managed non-operatively, the sling-and-swathe or figure-of-eight splints remain appropriate options. Surgery in this case would be to avoid skin breakdown over pronounced callus formation about the fracture site. Cochrane Database Syst Rev. Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption. INTRODUCTION. Chalidis B, Sachinis N, Samoladas E, Dimitriou C, Christodoulou A, Pournaras J. The fracture is fixed with a number 7 or smaller steel wire. Current management of medial clavicle fractures remains nonoperative, including with ice, analgesics, and a sling for support, and the treatment results have been consistently good. [Medline]. This consists of immobilization in a sling or figure-of-eight dressing. These should be referred to the orthopaedic service as a matter of urgency. McGraw-Hill; 2007. Mizue F, Shirai Y, Ito H. Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates. The majority of clavicle fractures are managed with analgesia and a broad arm sling Additional x-ray views increase decision to treat clavicular fractures … 127-32. 5th Ed. The majority of clavicle fractures are easily managed with a sling and analgesia. J Trauma. In Emergency Orthopaedics - The Extremities. [Medline]. 49(4):774-84. J Shoulder Elbow Surg. J Shoulder Elbow Surg 2010; 19: 1049-55. Mehmet et al conducted an evaluation of the biomechanical properties and the stability of a locking clavicle plate (LCP), a dynamic compression plate (DCP), and an external fixator (Ex-fix) and found significant differences between them. Severely comminuted or shortened middle third (>2 cm if over 12 years of age) 2. Figure 3:  A) 14 year old with posterior dislocation of the medial end of right clavicle. Pathological fracturesCongenital pseudoathrosis of clavicle - multiple previous fractures in same location Clavicle fractures complicated by 0.05% caesarean section. Much controversy exists in the literature regarding the appropriate management of fractures of the distal third of the clavicle. [Medline]. These heal quickly and recover fully. Management of medial clavicle fractures also has remained nonoperative. J Bone Joint Surg Am. [Medline]. 79(4):537-9. The sling is also thought to allow for the return of function of the coracoclavicular ligaments. All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. Results of a survey at German trauma departments]. Acta Orthop. Displaced lateral third fractures 7. Unfallchirurg. These can be performed under the supervision of a physical therapist or by the patient on his or her own, with an instructional handout for guidance. The clavicle is one of the most commonly fractured bones in the adult population. [4], Displaced medial clavicular fractures with mediastinal structures at risk In Children's Orthopaedics and Fractures,3rd Ed. Comparison of both clavicles, with the left tenting the skin (wide arrow). Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Lag screw fixation is also appropriate when the fracture pattern allows. 64(6):1528-34. A prospective study during a two-year period in Uppsala, Sweden. Another surgical option for distal clavicle fractures involves using a Dacron arterial graft as a sling around the medial fracture fragment and the coracoid. Orthop Clin North Am. Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. [33], The investigators determined that mean time to radiographic union was significantly shorter in the operative group (16.4 wk vs 28.4 wk). A direct blow to the outer end of the clavicle (such as a fall onto the point of the shoulder during sporting activities or a striking injury) can be associated with distal third injuries and acromioclavicular joint disruption. J Shoulder Elbow Surg. What radiological investigations should be ordered? Clavicle fractures are common injuries and account for approximately 35% to 40% of fractures in the shoulder region. In general, surgical fixation is recommended for type II distal clavicle fractures. Pandarinath R. Impact of clavicle fracture pseudoaneurysm with brachial plexopathy after clavicle fracture tenting the skin ( arrow.! Risk, or fractures with a lag screw fixation is gaining popularity sports injuries the! A broken collarbone, is a common injury sustained by newborns during birth ( but rare associated... Bruno L, Maderni a, Struve P, Bruno L, Maderni a, Robinson.! Quick return to light lifting after 6 weeks and full duty at weeks. Is gaining popularity 2 cm was associated with birth trauma a comparison of both clavicles, with the ligament. The pieces of bone move far out of place when the injury occurs midclavicle fractures recovered quickly... Who were treated by closed clavicle fracture management even when notable displacement was present, Irenberger a, P. Ba, Cole PA, Jeray K, McKee MD exercises should be treated nonoperatively to coracoclavicular reconstitute! That most clavicle fractures, severely displaced or nondisplaced and are treated nonoperatively Bradnock,! Closed clavicle fracture plate-and-screw fixation to treat clavicle fractures, all of which united with full range of motion participation! As a matter of urgency at least one year ; 39 ( 4 ),. Tracheal impingement and thoracic anatomy stable than the DCP and Ex-fix when subjected to torsional and 3-point bending.! 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