Clavicle Fracture

INTRODUCTION
In children the clavicle fractures easily,
but it almost invariably unites rapidly
and without complications.
In adults this can be a much more
troublesome injury.

EPIDEMIOLOGY
In adults clavicle fractures 2.64
per cent.
Midshaft fractures 6982 per cent,
Lateral fractures 2128 per cent
Medial fractures 23 per cent

Anatomy

The clavicle is S-shaped

The first bone to ossify 5 week of gestation
It is widest at its medial end and thins laterally
The medial one-third protects:
Brachial plexus
Subclavian and axillary vessels
Superior lung

Ligament
Coracoclavicular
Trapezoid
Conoid
acromioclavicular

Mechanism of injury
A fall on the shoulder
The outstretched hand
the outer fragment is pulled down by
the weight of the arm
the inner half is held up by the
sternomastoid muscle.

Clinical features
The arm is clasped to the chest to
prevent movement.
A subcutaneous lump may be
obvious and occasionally a sharp
fragment threatens the skin

A careful neurovascular examination

to assess the integrity of neural and
vascular elements

Imaging
Radiographic analysis requires at least
an anteroposterior view
Another view with a 30 degree
cephalic tilt.
CT scanning with three-dimensional
reconstructions to determine
accurately the degree of shortening or
for diagnosing a sternoclavicular
fracture-dislocation

(a) Displaced fracture of

the middle third of the clavicle the
most common injury.

lateral of the clavicle

(b) A comminuted
fracture which united in this position

Classification
Classified on the basis of their location:
Group I (middle third fractures)
Group II (lateral third fractures)
(a) coracoclavicular ligaments intact
(b) coracoclavicular ligaments are torn or
detached from the medial segment
(c) factures which are intra-articular

Group III (medial third fractures).

TREATMENT

MIDDLE THIRD FRACTURES

That undisplaced fractures Treated
by non- operativel management:
applying a simple sling for comfort (13
weeks)
the traditional figure-of-eight bandage
the patient is then encouraged to
mobilize the limb as pain allows

MIDDLE THIRD FRACTURES

That displaced fractures
by simple splintage:
shortening of more than 2 cm
risk of symptomatic mal-union
mainly pain
lack of power during shoulder movements
increased incidence of non-union.

Operative treatment:
acute clavicular fractures associated with severe
displacement.

LATERAL THIRD FRACTURES

non-operative management
Most lateral clavicle fractures are
minimally displaced and extraarticular
the coracoclavicular ligaments are
intact
operative management
Displaced lateral third fractures are
associated with disruption of the

Operative treatment

Initial
K-wires
Suture and graft techniques
The newer locking plates.

Complication
EARLY
Pneumothorax
Subclavian vessels injury
brachial plexus injuries
LATE
Non-union
Mal-union
Stiffness of the shoulder

Reference
Koval, Kenneth J, Zuckerman Joseph D,
Clavicle Fracture, Upper extremity
fracture and dislocation,Handbook of
fracture, Lippincot Williams & Wilkins, New
York, 2006.
Solomon, Louis, Fracture and joint injuries,
Injury of the Shoulder, upper arm and
elbow, Apley,s system of orthopaedics and
fractures, Hodder Arnold, UK, 2010.