Clavicle Fractures

Edsel Sandoval MD
Alfonso Téllez MD
 General: Clavicle fracture

Fracture is fairly common—accounting for about 5%of all adult fractures.

Most occur in men younger than 25, men over 55, and women over 75.
Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm. In young
adults and children these injuries usually
Allman classification:
• Group I - mid shaft fractures - 75-80%
• Group II - lateral (distal third) fractures - 15-25%
• Group III - medial (proximal third) fractures - 5%
The mid-shaft is the thinnest and most easily fractured. The lack of ligamentous and muscular
 Fracture Types

Allman classification:
Group I - mid shaft fractures - 75-80%
Group II - lateral (distal third) - 15-25%
Group III - medial (proximal third) - 5%

Clavicle fractures vary. The bone can crack just slightly or break into many pieces
(comminuted fracture). The broken pieces of bone may line up straight or may be far out of
place (displaced fracture).
Presentation:

Most patients with clavicular fracture hold arm adducted close to the body and supported by
the other arm. This position limits weight of affected arm on fractured bone.
Physical Exam: ecchymosis, edema, focal tenderness, and crepitation.
Must evaluate neurovascular status as subclavian vessels, brachial plexus, and lung apex can be
injured in posteriorly displaced fractures.
Symptoms: Clavicle fracture

A clavicle fracture can be very painful and may make it hard to move your arm. Other signs
and symptoms of a fracture may include:
• Sagging of the shoulder downward and forward
• Inability to lift the arm because of pain
• A grinding sensation when you try to raise the arm
• A deformity or "bump" over the break
• Bruising, swelling, and/or tenderness over the collarbone
 Imaging

Radiography should be performed on all patients with suspected clavicle fractures.

Most fractures can be seen on a standard AP view (Figure 2). AP view with 45-degree cephalic
tilt minimizes overlap of the ribs and scapula and allows for better assessment of displacement
in AP plane (Figure 3).
 Mid-Clavicle fracture

The medial segment is pulled superiorly by the sternocleidomastoid. The weight of the arm
pulls the lateral segment inferiorly through the coracoclavicular ligaments, but is opposed by
the trapezius.
 Mid-Clavicle fracture
CHILDREN

• The mean age with sports-related clavicle fractures is 21 yrs.

• The mean age non-neonatal clavicle fractures is 8 yrs.
• 88%of these fractures are midshaft.
• Nearly all midshaft clavicle fractures in children heal well due to great periosteal
regenerative potential.
• Children often develop a significant callus formation; It is important to educate parents
about this normal progression of healing.
• Healing usually occurs within 4-6 weeks.
 Distal-Clavicle fracture

Neer classification of distal clavicle fractures:

• Type I: Coracoclavicular ligaments remain intact
• Type II: Coracoclavicular ligaments are torn from the medial fragment and only the
trapezoid ligament remains attached to the lateral fragment.
• Type III: Extension into the AC joint
• Type IV:
Types Involve
I and disruption
III fractures of the periosteal
inherently stable andsleeve
not rather than an actual bone fracture
• Type V: Involve
displaced; avulsion
therefore, can beoftreated
the ligaments with a small inferior cortical fragment.
nonoperatively.
•
Bony union by 6 weeks.
• Return to contact sports should be delayed for 2-4
months until the bony union is solid.
• Type II distal clavicle fractures have a tendency to
displace, and their management is controversial
 Proximal-Clavicle fracture

• The proximal clavicle and sternoclavicular joint also have good ligamentous support, so
fractures do not typically displace.
• Nondisplaced fractures can be treated with a sling for comfort and gradual increase in range
of motion, as pain allows.
• Displaced fractures should be evaluated for neurovascular compromise; if present, this
should be acutely reduced.
• In a setting capable of handling an airway or hemodynamic emergency, this reduction can be
achieved acutely by grasping the clavicle with a towel clip and applying anterior traction
 Nonunion: Clavicle fracture

• Displaced midshaft clavicle fractures have higher rates of

nonunion and a greater risk of long-term sequelae.
• Operative treatment results in a lower rate of fracture nonunion
and improved outcomes compared with nonoperative treatment.
• Operative repair should be considered in patients with multiple
risk factors for nonunion, especially significant fracture
displacement or clavicle shortening.
• Patients usually can return to non-contact sports and full daily
activities 6 weeks
• Contact and collision sports should be delayed for 2-4 months
Key Recommendations:
 Summary

• Clavicle fractures are most common in children and young adults

• midshaft most common site for injury. Mechanism of injury is a forceful fall with the arm at
the side
• Diagnosis can often be made by the H&P; Appropriate radiography should be used to
confirm the diagnosis and guide treatment options.
• Most clavicle fractures occur in the midshaft and can be treated nonoperatively. A prominent
callus is common in children, and parents may require reassurance.
• Surgery an option in fractures with high potential for nonunion (e.g., displaced or
communited fractures, fractures with more than 15 to 20 mm clavicle shortening).
•