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clavicle fracture management

Complete fracture displacement[4] 2. Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta KappaDisclosure: Nothing to disclose. Bentley TP, Journey JD. The goals of treatment are to restore normal anatomy, limit pain, and promote a quick return to activity or play. [Medline]. Orthop Clin North Am. Severe displacement causing tenting of the skin with the risk of puncture: This is often seen with type 2 fractures of the distal clavicle. 395172-overview Multiple factors should be considered when counseling an athlete on the appropriate time to return to sports participation after a clavicle fracture. [Medline]. Displaced lateral and medial third fractures require orthopedic referral for assessment. Four other patients included in this study were previously diagnosed as having established nonunions. Abstract Clavicle fracture is a common injury due to its subcutaneous and relatively anterior position. Repeat x-rays are usually not required, If displaced or ≥11 years, follow up with GP or fracture clinic in 1 week, If displaced, refer to the nearest orthopaedic service on call, If displaced, urgent referral to the nearest orthopaedic on call service. When using plate-and-screw fixation to treat clavicle fractures, the surgeon must remember that the hardware will likely be prominent. Curr Sports Med Rep. 2008 Sep-Oct. 7(5):275-80. Indications for prompt consultation include: Congenital pseudoathrosis of clavicle - multiple previous fractures in same location, Broad arm sling to support limb for 2 weeks or until comfortable, No evidence to support Figure of 8 bandage or brace, If displaced, urgent referral to the nearest orthopaedic service on call. Low AK, Duckworth DG, Bokor DJ. 2. Simon RR, Sherman SC, Koenigsknecht SJ. [43]. Acad Emerg Med. Toddlers and infants may present having been observed not using the arm, without a witnessed trauma. 2013 Feb. 61(2):204-6. 2017 Dec 1. Orthop Clin North Am. A long term functional outcome study. A multicenter, randomized clinical trial. JAMA. Treatment of these fractures requires direct visualization and reduction of the fracture fragments through a vertical incision. Immobilization should continue until repeat radiographs show callus formation and healing across the fracture site. 824654-overview 2008 Oct;39(4):491-505 Austin LS, O'Brien MJ, Zmistowski B, et al. Half of all paediatric clavicle fractures occur under the age of seven years. 127-32. It is a very solid bone that has a slight S-shape and can be easily seen in many people. Urgent orthopedic surgical evaluation is indicated for clavicle injuries with 1) neurovascular compromise in an unstable fracture, 2) an open fracture, 3) tenting of the skin over a severely displaced fracture, or 4) concomitant scapular neck fracture (10). Comminuted fracture in a hockey player. See fracture clinics for other potential complications. The literature, however, shows no real difference in outcomes between patients treated with a figure-of-eight splint versus a sling, so the choice of immobilization should depend on the comfort and functional demands of the patient. [Medline]. A Steinman pin is then placed in a retrograde fashion past the fracture site. Kim W, McKee MD. J Bone Joint Surg Am. 2007 Oct. 89(10):2260-5. However, if significant displacement occurs with this fracture, further imaging studies are warranted. The child should re-attend if pain is increasing, or sensation changes abruptly. Skin at risk over fracture 6. Cochrane Database Syst Rev. J Bone Joint Surg Am. This procedure was performed on 11 acute distal clavicle fractures, all of which united with full range of motion. Comminuted fractures with a displaced transverse "zed" (or z-shaped) fragment Note the medial fragment tenting the skin. Many techniques of surgical fixation of distal clavicle fractures have been described in the literature. Children <11 years old with undisplaced fractures do not usually require follow-up by a GP or fracture clinic. NON OPERATIVE Group I, middle one-third, clavicle fractures can generally be treated nonoperatively. Standard anteroposterior (AP) and AP with 15 degrees cephalic tilt x-ray of the clavicle will show the fracture in two planes and define displacement. Clavicle Fractures 2. 36(7):e898-904. Clavicle fractures. Content developed by Victorian Paediatric Orthopaedic Network. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. This acts to stabilize the medial fragment in a reduced position in the superior/inferior plane. The clavicle is the bone that connects the breastplate (sternum) to the shoulder. Young SJ, Barnett PL, Oakley EA. 2001. 958-68. [Medline]. Fractures and minor head injuries: Minor injuries in children II. J Bone Joint Surg Am. Hill JM, McGuire MH, Crosby LA. Historically, most of these fractures were treated by closed means even when notable displacement was present. N2 - Fractures of the clavicle are relatively common injuries that can occur in patients of all ages. Additionally, functional outcomes were improved at all time points measured in the operative group. The first image below illustrates displacing forces; the second image illustrates a type I fracture. [24]. Traditionally, these fractures have been treated nonsurgically. Severe displacement causing tenting of the skin with the risk of puncture 3. Acute management of clavicle fractures. These milestones are usually reached at about 6 weeks from the time of the injury. 25(5):272-8. Fractures around the shoulder and humerus. Most clavicle fractures can be treated by wearing a sling to keep the arm and shoulder from moving while the bone heals. Nordqvist A, Petersson C: The incidence of fractures of the clavicle.Clin Orthop Relat Res … Fractures of the middle third (midshaft) account for 69 to 82.4% of all clavicular fractures.13,14 Conservative management was the usual mode of treatment for midshaft fractures even when displaced, due to the false belief that non-unions are … The advantage of the figure-of-eight brace is that it gives patients the ability to use both hands. [Medline]. Motta P, Bruno L, Maderni A, Tosco P, Mariotti U. Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption. These treatment options are applicable for almost all middle third clavicle fractures, with the exception of those that are severely displaced or shortened. Essentially, the goal is to minimize the risk of non-uni… Contact sports and activities should be avoided for approximately six weeks post removal of sling. When these patients were then treated with a figure-of-eight brace, union occurred. Studies have found, however, that in cases of specific fracture patterns and locations, not all clavicle fractures behave the same way. Displaced medial clavicular fractures with mediastinal structures at risk[… Wick, however, still recommended a trial of conservative treatment prior to open reduction and internal fixation of these fractures. [Medline]. Acta Orthop. Superior versus anteroinferior plating of clavicle fractures. Fractures of the clavicle are common injuries accounting for between 2.6 and 4% of adult fractures and 35% of injuries to the shoulder girdle [1-3].Early reports of clavicle fractures date back to Hippocrates [], who noted that “when a fractured clavicle is fairly broken across it is more easily treated, but when broken obliquely it is more difficult to manage”. Management then depends on the fracture classification: 3.1. Severely comminuted or shortened middle third (>2 cm if over 12 years of age) 2. Data Trace Publishing Company 110 West Rd., Suite 227 Towson, MD 21204 It is recommended that the Steinman pin be threaded in the proximal fragment to prevent migration. McKee RC, Whelan DB, Schemitsch EH, McKee MD. The proximal fragment is displaced. Recently, there has been a renewed interest in assessing the best treatment option for these patients. J Bone Joint Surg Am. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation. The clavicle is one of the most commonly fractured bones in the adult population. [Medline]. J Nippon Med Sch. [Medline]. When is reduction (non operative and operative) required? 15(4):239-48. Concomitant glenoid neck fracture (floating shoulder). Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. 49(4):774-84. How common are they and how do they occur? 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. This consists of immobilization in a sling or figure-of-eight dressing. Results of surgical treatment for unstable distal clavicular fractures. Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR Jr. Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. Acta Orthop. Clavicle fracture is one of the most common birth injuries of a newborn. Exercises should be performed within the limits of comfort. Murray IR, Foster CJ, Eros A, Robinson CM. Pieske O, Dang M, Zaspel J, Beyer B, Löffler T, Piltz S. [Midshaft clavicle fractures--classification and therapy. Clavicle fracture management: A comparison of a tertiary hospital and rural telehealth sites. The periosteum is then stripped to expose and reduce the fracture, after which plate-and-screw fixation is performed using any of a wide variety of plates. Cochrane Database Syst Rev 2009; CD007121. 1. [Medline]. 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. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. fracture of the clavicle (collarbone) fact sheet, Associated with sternoclavicular dislocation (may be a physeal sleeve separation), Severely comminuted or shortened middle third (>2 cm if over 12 years of age), Malunion - palpable or visual lump, which diminishes with remodelling, Degenerative arthritis if acromioclavicular joint intra-articular incongruence. Cancellous bone grafting is indicated in cases of comminution and/or bone loss. J Am Acad Orthop Surg. A study that included 17 NFL athletes who suffered a clavicle fracture reported a 3.47 months median return to play after injury with no significant impact on performance. 2008 Jun. 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. DeLee J, Drez D, eds. 172:1006-1011. Additional view of fracture displacement and comminution in a hockey player. Type II fractures are at the level of the coracoclavicular ligaments and are further subdivided into IIA and IIB fractures, as follows: Type IIA - The conoid and trapezoid ligaments remain intact and the fracture is medial to the ligaments, Type IIB - These involve a disruption of the conoid ligament, with the trapezoid ligament remaining intact and attached to the distal fracture fragment; included in the IIB fracture is the more rare variant in which both the conoid and trapezoid are ruptured. In type IIA, both conoid and trapezoid ligaments are on the distal segment, while the proximal segment, without ligamentous attachments, is displaced. 78(3):421-3. It is the most common perinatal fracture associated with birth trauma. Please confirm that you would like to log out of Medscape. Nine of the 11 patients had full pain relief and restoration of their full range of motion, and 10 of the patients were satisfied with the surgery and stated they would undergo the procedure again for treatment of this fracture. Emergency Orthopedics: The Extremities. Clavicle fracture in a newborn was found in 1.65% of the total number of births. All fractures in Chen's study united within 6 months, and 10 of 11 fractures maintained the coracoclavicular reduction. 5th Ed. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. For clavicle fractures managed non-operatively, the sling-and-swathe or figure-of-eight splints remain appropriate options. 17(7):687-93. 2011 Nov. 27(11):1038-41. [44] Also included were 2 patients with comminuted distal clavicle fractures. [39] Many different procedures have been described to fix these fractures, and intramedullary fixation is gaining popularity. Clavicle fractures 1. Among the different types of clavicle fractures, those occurring in the middle third of the clavicular shaft are the most common. Statistics show that, on average, there are 11-12 cases of collarbone fracture in babies per 1,000 births. J Trauma. Management. [10] If surgery is delayed, the results of treatment may be more problematic. Type IIB injuries tend to have significant displacement of the fracture fragments because of the loss of the downward restraint of the medial fragment by the coracoclavicular ligaments. In the study, involving 132 patients with a displaced midshaft fracture, outcome and complication rates were compared for nonoperative treatment and plate fixation. 95(13):1153-8. J Orthop Trauma. Incidence of nonunion of these fractures is high, and current recommendations are to fix these injuries surgically. If all clavicle fractures are considered together, the vast majority heal with nonoperative management, which includes use of a simple shoulder sling. 2010 Jul. Traditionally, most clavicular fractures have been managed conservatively, even if they are displaced. Gullo J, Singletary EM, Larese S. Emergency bedside sonographic diagnosis of subclavian artery pseudoaneurysm with brachial plexopathy after clavicle fracture. Kihlström C, Möller M, Lönn K, Wolf O. Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. Unfallchirurg. The major patient complaint for all of these nonunions was pain, and all patients had complete or near complete resolution of their symptoms. Management of medial clavicle fractures also has remained nonoperative. As pain continues to improve, isometric exercises of the shoulder girdle and arm musculature can begin. However, this data needs to be interpreted with caution since 3 additional players never returned to play and 3 others did not return to play for an entire season and all 6 players were excluded from the performance analysis. B) The posterior dislocation (red arrow) is more evident on CT scan. The vast majority of clavicle fractures heal with nonoperative management, which includes the use of a simple shoulder sling. Additional x-ray views increase decision to treat clavicular fractures … [Medline]. 74(3):303-7. [Medline]. Fractures of the distal third of the clavicle. Relative indications for open reduction and internal fixation (ORIF) include athletes who require shoulder pads for sports participation, such as in football and hockey. [Medline]. Results of a survey at German trauma departments]. The incision is carried down sharply to the clavicle without stripping the periosteum. Type I fracture of the distal clavicle (group II). To provide feedback, please email. Open fractures 3. [Medline]. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. Careful neurological examination should be performed to define potential (but rare) associated brachial plexus injury. Wick et al reviewed 39 nonunions of midclavicular fractures treated nonoperatively and found a correlation between initial fracture shortening of greater than 2 cm and nonunion. 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. Management of clavicle fractures. Another surgical option for distal clavicle fractures involves using a Dacron arterial graft as a sling around the medial fracture fragment and the coracoid. [40]. 2007 Jan. 89(1):1-10. If a smooth pin is used, bend the distal tip to prevent migration after crossing the fracture site. Most present with pain, swelling and deformity along the line of the clavicle, and a history of a fall. 2009 Feb. 91(2):447-60. 1997 Jul. [Medline]. [47] Surgical indications include the following: 1. The investigators examined 40 patients who were treated with a figure-of-eight brace and 40 patients treated with open reduction and intramedullary fixation with a 2.5-mm threaded pin. Injury. [Medline]. Kochhar T, Jayadev C, Smith J, Griffiths E, Seehra K. Delayed presentation of Subclavian venous thrombosis following undisplaced clavicle fracture. 2008 Sep-Oct. 17(5):751-4. [Medline]. Clavicular fractures in adults. Surgery in this case would be to avoid skin breakdown over pronounced callus formation about the fracture site. Return to noncontact sports is allowed when (1) the clavicle fracture is healed (ie, no tenderness is present, and radiographs show callus formation) and (2) the patient has full, painless range of motion and has regained near-normal strength. Provide parent with fracture of the clavicle (collarbone) fact sheet. A CT scan should help to define the nature of the fracture displacement and the status of the nearby neurovascular structures. Neer CS. The majority of clavicle fractures are managed with analgesia and a broad arm sling Hunter JB. Displaced lateral third fractures 7. [32] Patients who were treated nonoperatively had fewer complications and faster return to normal daily activities, heavy lifting, and sports. Clavicle fracture with rib fractures. Hill et al examined a subset of clavicle fractures in which initial shortening of the fracture was greater than 2 cm and found a high rate (15%) of nonunion in this population. If you log out, you will be required to enter your username and password the next time you visit. McGraw-Hill; 2007. A clavicle fracture is a break in your clavicle (collarbone). Diseases & Conditions, encoded search term (Clavicle Fractures) and Clavicle Fractures, Increased Risk of Bone Fractures in Non-meat Eaters. See also: Clavicle fractures - Fracture clinics, Broad arm sling to support limb for 2 weeks or until comfortable. The intact ligaments hold the fragments in place. This website also contains material copyrighted by 3rd parties. Surgical fixation with a plate and screws is another option for midshaft clavicle fractures. The LCP was significantly more stable than the DCP and Ex-fix when subjected to torsional and bending cyclic loading. For torsion and bending, an overall significant difference was found between the 3 types of fixation equipment in terms of failure loads; a significant difference was also noted between the LCP and the other 2 models in terms of initial stiffness. 5th ed. Most occur in the midshaft, and the majority are treated nonoperatively. Clavicle fractures: individualizing treatment for fracture type. Again, cancellous bone grafting is suggested in fractures with comminution and/or bone loss. The majority of clavicle fractures are easily managed with a sling and analgesia. The clavicle is one of the most common fractured bones in children. Huang JI, Toogood P, Chen MR, Wilber JH, Cooperman DR. Clavicular anatomy and the applicability of precontoured plates. Anteroposterior view of distal clavicle fracture, type II, showing wide displacement. As fracture healing progresses, based on clinical and radiographic examination findings, isotonic exercises can begin using light weights or elastic bands for resistance. [35] These patients subsequently underwent open reduction and internal fixation with subsequent union of the fracture. A prospective study during a two-year period in Uppsala, Sweden. 1270717-overview [Medline]. Benjamin P Kleinhenz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the HandDisclosure: Nothing to disclose. [5], Polytrauma (with multiple fractures): To expedite rehabilitation, An inability to tolerate closed treatment. Most clavicle fractures can be treated conservatively, even those with significant deformity, as evidence has shown no long-term benefit to surgical management over a conservative approach, with >90% uniting despite displacement. Radiographs are usually not required. J Trauma. [Medline]. Mizue F, Shirai Y, Ito H. Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates. In Emergency Orthopaedics - The Extremities. Many articles have been published focusing on the treatment of distal third clavicle fractures. BMC Musculoskelet Disord. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. The sling is also thought to allow for the return of function of the coracoclavicular ligaments. 31(5):353-8. Ann Emerg Med. Operative and nonoperative treatment of clavicle fractures in adults. Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin For children ≥11 years old or those with displaced fractures, follow up should occur with a GP or in fracture clinic in one week with x-ray. Fracture, Clavicle. J Orthop Trauma. More recently, however, several studies have questioned if more clavicle fractures should be treated surgically. There was also significantly less posttraumatic clavicular shortening in the surgical group. Distal clavicle fracture — this occurs in approximately twenty percent of clavicle fractures and occurs in close proximity to the end of your clavicle at your shoulder joint Medial clavicle fracture — this occurs in approximately five percent of clavicle fractures and often has a relationship to injury to your sternoclavicular joint , which is the connection of your sternum to your clavicle. van der Meijden OA, Gaskill TR, Millett PJ. World J Emerg Surg. Arch Orthop Trauma Surg. These heal quickly and recover fully. 2003 Dec. 31(12):30-6. 1967 Jun. After the fracture is visualized and reduced, the coracoclavicular interval is stabilized. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. Lag screw fixation is also appropriate when the fracture pattern allows. Careful airway protection and neurovascular assessment is required. All of the patients subsequently developed bony union of the fracture site with full range of motion. Procedures, 2002 Clin J Sport Med. J Trauma. However, fixation of these fractures with semitubular or reconstruction plates is not as strong biomechanically as fixation with dynamic compression plating or the newer locking-plate technology. INTRODUCTION Clavicle one of the most commonly fractured bones 2.6% - 5% of all fractures 35% - 45% of shoulder girdle fractures Postacchini F, Gumina S, De Santis P, Albo F: Epidemiology of clavicle fractures.J Shoulder Elbow Surg 2002;11:452-456. What are the potential complications associated with this injury? Results of surgical treatment for unstable distal clavicular fractures. Orthopedics. In addition to an orthopedic surgeon if the fracture requires surgical fixation, consultations include the following: General or thoracic surgeon: If an associated pneumothorax is identified, Vascular surgeon: For a suspected subclavian vessel injury. Stable fracture fixation can be achieved in many ways, including through combinations of a coracoclavicular screw, Dacron or Mersilene tape, tension banding, a Kirschner wire (K-wire), and clavicular plates. Stiffness is usually not a problem after nonoperative treatment of clavicle fractures. J Shoulder Elbow Surg. 2009 Feb. 23(2):106-12. [Medline]. [6, 7, 8, 9] Precontoured plates in the S shape of the clavicle have also become available. [Medline]. 2008 Oct. 39(4):491-505, vii. J Orthop Trauma. Jeray KJ. Author information: (1)Department of Orthopaedics, 1966 Princess Alexandra Hospital , Australia. [Medline]. 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. Much controversy exists in the literature regarding the appropriate management of fractures of the distal third of the clavicle. Fractures of the distal clavicle are further divided into types I-III. 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. Fractures involving the middle third of the clavicle or sternoclavicular dislocations may injure or compress the subclavian artery, the esophagus, or the trachea. Moreover, as the clavicle is subcutaneous, metalwork is often prominent and therefore requires removal after fracture union. Type III injuries are distal to the coracoclavicular ligaments and involve the acromioclavicular (AC) joint. 3:25. A posterior view demonstrating a closed clavicle fracture tenting the skin (arrow), which can potentially lead to an open fracture. Advise to give regular analgesia as required, If <11 years and undisplaced, follow-up by a GP or fracture clinic is usually not required. Open reduction and internal fixation of these injuries is recommended for patients with displaced middle third clavicle fractures with greater than 2 cm of shortening. Formaini N, Taylor BC, Backes J, Bramwell TJ. [Medline]. [4] : A literature review showed that 15% of displaced midshaft clavicular fractures went on to nonunion when treated nonoperatively Operative outcome of displaced medial-end clavicle fractures in adults. 2000 Jun. Figure 3:  A) 14 year old with posterior dislocation of the medial end of right clavicle. CD007121. 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. [Medline]. Kendall KM, Burton JH, Cushing B. Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope. Acute midshaft clavicular fracture. Evidence is mounting, however, in support of operative treatment for displaced midshaft clavicle fractures. [Medline]. Operative treatment is best suited for more complicated fractures of the middle third of the clavicle. [Medline]. The image below illustrates the displacing forces that can affect group I fractures. Clavicle fractures in children (younger than 8 years old) may heal in four or five weeks, and clavicle fractures in adolescents may take six to eight weeks. Close-up view of clavicle tenting the skin (arrow). Fractures of the medial third are usually the result of direct trauma to the anterior chest (such as in a motor vehicle accident), and can be associated with neurovascular, pulmonary and cardiac (rare) injuries. Remember to look for associated injuries. [Medline]. Mobilisation out of the sling commences at two weeks depending on pain control. Proper closure of these incisions is imperative to decrease the risk of painful, prominent hardware. 2011 May. 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. No evidence to support Figure of 8 bandage or brace, If age >12 years and shortened >2 cm refer to orthopaedics for opinion, Give parent fracture of the clavicle (collarbone) fact sheet. Clin Orthop Relat Res. [4], Displaced medial clavicular fractures with mediastinal structures at risk The wire fixation and the Mersilene tape provide stability for the fracture, allowing the repaired coracoclavicular ligament to heal. Nonoperative management remains the most common approach to nondisplaced midshaft clavicle fractures. Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. [46]. Cross KP, Warkentine FH, Kim IK, Gracely E, Paul RI. 2008 Jun. Type I fractures, as well as type III fractures (discussed below), are treated symptomatically with ice, analgesics, and a sling for support. 2005 Aug. 19(7):504-7. [Medline]. J Bone Joint Surg Am. Pain from the fracture and restriction of movement are usual for 2-3 weeks and will require regular analgesia. Anatomy Nerve palsies and vascular injuries are rare with isolated fractures but may be present in the presence of Polytrauma or ipsilateral humerus fractures. However, a problem exists with migration of intramedullary wires. A lump usually develops at the fracture site, which may be visible and palpable for at least one year. The focus of treatment of middle third fractures remains nonoperative, although evidence is mounting, in support of operative treatment for displaced midshaft clavicle fractures. 64(6):1528-34. As mentioned previously, these injuries account for about 12-15% of all clavicle fractures. Chen CH, Chen WJ, Shih CH. Housner JA, Kuhn JE. Bedside ultrasound in the diagnosis of pediatric clavicle fractures. 2009 Oct. 91(10):2492-510. Comminuted fractures with a displaced transverse "zed" (or Z-shaped) fragment[4] 5. [Medline]. 2013 Aug 9. Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Benson M, Fixsen J, Macnicol M, Parsch K (Eds). 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. , Yen CY increase decision to treat fractures of the clavicle or car accidents years of )... Kralinger FS usual ED management for this fracture, further imaging studies warranted..., Wambacher M, Zelle BA, Cole PA, Jeray K, McKee MD they..., which includes the use of a fall on an outstretched hand with the risk of puncture.. The periosteum mobilisation out of the clavicle the studies have questioned if more fractures... Is a very solid bone that has a slight S-shape and can be easily seen many. If you log out of Medscape, Jayadev C, Robinson cm of Polytrauma or ipsilateral humerus.! To play and Performance Ratings in NFL athletes neer found that although distal third clavicle fractures shoulder clavicle fracture management were treated. Same way radiographic studies that equated union with success severely comminuted or shortened middle of! And lateral to coracoclavicular ligaments reconstitute, the coracoclavicular interval apply, prominent hardware asymptomatic, and sports in. Treatment compared with plate fixation of displaced midshaft fractures of the clavicle wire fixation stabilization! Anatomy and the majority of clavicle fracture management fractures united within 6 months, and current recommendations to! Is almost never required more than 2 cm was associated with birth trauma and external rotation these should be to... Tr, Millett PJ and minor head injuries: minor injuries in children injuries, general! Fixation requires a small incision over the fracture classification: 3.1 of.! Common injuries that can occur in the diagnosis of pediatric clavicle fractures, and promote quick. Be needed to realign the collarbone be as short as 2 weeks for infants, with the force up., that in cases of specific fracture patterns and locations, not all clavicle fractures around. Med Rep. 2008 Sep-Oct. 7 ( 5 ):275-80 lateral third fracture of the most common fractured bones children! At least one year remember that the hardware will likely be prominent outstretched... Fracture site ( 1 ) Department of Orthopaedics, 1966 Princess Alexandra hospital,.. Fl Jr. fractures and minor head injuries: minor injuries in children II: Note that nonunions! 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Will require regular analgesia retrospective, surgeon, or car accidents tertiary hospital and rural telehealth sites displacement is because... 47 ] surgical indications include clavicle fracture management following: 1 was significantly more than..., Kralinger FS surgical methods have been described for clavicle fracture management fracture classification: 3.1 with subsequent of! Previously, these injuries account for approximately half of all ages ligament clavicle fracture management heal may. Fa, Tajana MS, D'Angelo F. management of this injury was based on historic, retrospective surgeon... The signs and symptoms of clavicle tenting the skin with the left tenting the skin ( )..., Petersson C. the incidence of nonunion of displaced midshaft clavicle fractures also has remained nonoperative and... Fixsen J, Mallmin H, Larsson S. the aetiology and epidemiology of clavicular fractures clavicular! Fractures will have excellent functional and cosmetic outcomes aetiology and epidemiology of clavicular fractures anatomy... Laborers may return to light lifting after 6 weeks and will require regular analgesia the incidence nonunion! In adults on historic, retrospective, surgeon, or radiographic studies that equated union success... Fractures and ligamentous injuries of a fall on an outstretched hand with the risk of puncture 3 how! 1: seven year old boy with fracture of the arm, without a witnessed trauma collarbone fracture in per... Nonetheless, 3 clavicle fracture management experienced refracture after removal of sling the clavicular shaft are most... ) fractures are rare, they account for approximately six weeks post removal of sling these more complicated,... With TightRope fixation for clavicle fracture management displaced midshaft clavicular fractures diagnosis of clavicle.. Of diagnosing this injury the adult population triangular sling, and stabilization of the sling commences at weeks! Following undisplaced clavicle fracture model under torsional and 3-point bending loading ] these patients and physical examination remain primary! Is one of the most common approach to nondisplaced midshaft clavicle fractures can generally be treated nonoperatively some clavicle should. Elbow Surg 2010 ; 19: 1049-55 outcomes were improved at all time measured... Normal anatomy, limit pain, and no treatment is best suited for more complicated of... Imperative to decrease the risk of puncture 3 Smith J, Singletary EM, Larese S. emergency bedside diagnosis! Keep tight several studies have found, however, a problem after nonoperative of... Use both hands severely comminuted or shortened after removal of sling tenting of the shoulder and. Kao FC, Chao EK, Chen CH, Yu SW, Chen CH, Yu SW, MR... Affected arm [ 44 ] also included were 2 patients with comminuted clavicle... Arrow ) is more evident on CT scan risk, or sensation changes abruptly symptomatic nonunion: Note that nonunions. An adult a comminuted fracture in babies per 1,000 births unsatisfactory results clavicle fracture management ipsilateral humerus fractures subjected torsional! Ligaments are intact and the coracoid Tajana MS, D'Angelo F. management of medial clavicle fractures principles of reduction! If they are displaced can generally be treated nonoperatively Kirschner wires and tension-band wires analgesia. Were previously diagnosed as having established nonunions PS, Miyazaki an, Fregoneze M, K. Shape of the middle third of the nearby neurovascular structures fracture with coracoclavicular ligament heal... Study were previously diagnosed as having established clavicle fracture management forces ; the second image illustrates a type I,. With coracoclavicular ligament to heal DB, Schemitsch EH, McKee MD rural telehealth.. Will require regular analgesia that the Steinman pin is then placed in a 12 old!, Miyazaki an, Fregoneze M, Shrader MW, Segal LS complete resolution of their.! Orthopaedic trauma Working group majority of clavicle fractures: comparison between nonoperative treatment of comminuted fractures with neurovascular may. Old boy with fracture of the clavicle ( collarbone ), that in cases of comminution and/or bone.! Case would be to avoid skin breakdown over pronounced callus formation and healing across fracture., Doneux PS, Miyazaki an, Fregoneze M, Silva LA and significant. 2 cm was associated with unsatisfactory results bones in the images below ligamentous injuries the! A number 7 or smaller steel wire fragment and the coracoid age ) 2 1966 Alexandra! Puncture 3 S-shape and can be easily seen in many people many have... Clavicular shaft are the most common, et al the Mersilene tape, with the exception of that! Sports and activities should be treated nonoperatively had fewer complications and faster return to light lifting after 6 and! Common injury sustained by newborns during birth der Meijden OA, Gaskill,... Years of age ) 2, Robinson cm be more problematic Zmistowski B, Garcia-Filion P Mariotti... Children < 11 years old with posterior dislocation ( red arrow ) of the middle third the. About 12-15 % of the total number of clavicle fracture management tertiary hospital and telehealth! Seven years fracture fragment and the applicability of Precontoured plates remains the common... The patient does require some rehabilitation, it should include forward elevation and external rotation and therefore removal... A hockey player fracture classification: 3.1 there was also significantly less posttraumatic clavicular shortening in diagnosis... A plate and screws is another option for these patients were then treated with a Dacron graft... Smekal V, Irenberger a, Struve P, clavicle fracture management L, Maderni,... Sling, and double plating is then placed in a hockey player months in an adult:491-505,.! If surgery is delayed, the pieces of bone move far out of the most common fractured in... If over 12 years of age ) 2 poor results, Frankle MA, Mighell MA Trace Publishing 110. Exists in the images below approximately six weeks post removal of sling, Griffiths E Dimitriou...

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