Clavicle Fracture

Last updated 25.08.13

 

Definition

-  Fracture of clavicle

 

Features

-  Difficult to reduce & maintain reduction of fractured clavicles

-  Most common childhood fracture

 

Types

-  Class A: Middle 3rd

-  80%

-  Most medial to coracoclavicular ligament at junction middle & lateral 3rds

-  Class B: Lateral 3rd

-  15%

-  Most distal to coracoclavicular ligament

-  Type I: non-displaced, ligaments intact

-  Type II: displaced + rupture of coracoclavicular ligament

-  Type III: AC joint involved

-  Class C: Medial 3rd

-  5%

-  Commonly ass w other injuries due to amount of force required

 

Clavicle Fracture

 

Mechanism

-  FOOSH

-  Shoulder dystocia in neonate

-  Class A: direct force to lateral aspect of shoulder

-  Class B: direct blow to superior aspect of shoulder

-  Class C: direct blow to anterior chest

 

Associated S/S

-  Position

-  Distal clavicular fragment + arm sags

-  Proximal fragment elevates

-  Arm held close to body, adducted & supported

-  Inferior & anterior displacement of shoulder

-  Pain worse on movement of ipsilateral upper limb

-  Swelling

-  +/- step deformity

 

Complications

-  Brachial plexus injury from bone fragment

-  Midshaft fracture w malunion: medial cord syndrome (esp ulnar nerve)

-  Thoracic outlet syndrome

-  Erbs palsy

-  Ass scapula fracture = floating shoulder

-  Pneumothorax

-  Open fracture

 

Ix

-  Shoulder exam

-  Upper limb Neuro exam

-  X-ray shoulder (inc serendipity view)

-  +/- CXR is suspecting pneumothorax

 

Clavicle Fracture on X-Ray

 

Mx

-  RICE

-  Analgesia

-  Paracetamol OR Panadeine Forte

-  NSAIDs: Ibuprofen

-  Sling

-  Figure of eight splint

-  OR Arm sling

-  Remains until x-rays demonstrate callus formation, 4-6 weeks

-  Usually rapid healing

-  Even w deformity

-  Non-union & malunion

-  Absence of radiographic healing at 4 months

-  Typically occurs in central third

-  Non-union

-  High incidence in distal fracture & more severe injuries

-  Malunion

-  More typical w midshaft fracture

-  Surgery

-  Consider in

-  Class A if >2cm shortening

-  Class B Type II to prevent non-union

-  Intramedullary pin fixation

-  Iliac crest bone graft for non-union/malunion

 

 

 

 

References

 

Wheeless Textbook of Orthopaedics: www.wheelessonline.com/ortho/clavicle_fractures

eMedicine (incl Pic of model): emedicine.medscape.com/article/824564-overview

Pic (X-ray): shoulderville.blogspot.com/2008/06/clavicle-fractures.html