18 Clavicle Fracture



Matthew Baker and Uma Srikumaran


Summary


Clavicle fracture account for approximately 5% of adult fractures and there continues to be controversy in the ideal treatment.




18 Clavicle Fracture



I. Epidemiology




  1. Young active patients



  2. Displacement:




    1. Medial:




      1. Sternocleidomastoid (SCM): Pulls medial fragment posteromedially.



    2. Lateral:




      1. Weight of arm and pectoralis pull lateral fragment inferomedially.



    3. Open fractures → fragment buttonholes through the platysma.



  3. Associated injuries are rare but include:




    1. Scapulothoracic disassociation



    2. Ipsilateral scapular fracture



    3. Neurovascular injuries



    4. Rib fracture



    5. Pneumothorax



    6. Lateral 1/3 fractures can have concomitant glenohumeral pathology.



II. Anatomy




  1. “S” shape with six muscular attachments



  2. Acts as a strut connecting the axial and appendicular skeleton



  3. Sternoclavicular joint medially



  4. Acromioclavicular joint laterally



  5. The first bone to start ossification and the last one to complete union.



III. Classification




  1. Neer:




    1. Middle Third (Group 1):




      1. Nondisplaced:




        • i. <100% displacement.



      2. Displaced:




        • i. >100% displaced.



    2. Lateral third (Group 2):




      1. Type 1:




        • i. Nondisplaced



        • ii. Fractures occur between the acromioclavicular (AC) and coracoclavicular (CC) ligaments and ligaments are intact



        • iii. Treatment is nonoperative.



      2. Type 2:




        • i. 2A:




          • CC ligaments attached to distal fragment.



        • ii. 2B:




          • Trapezoid ligament intact



          • Conoid ligament torn.



        • iii. Highest rate of nonunion



        • iv. Consider open reduction and internal fixation (ORIF):




          • Hook plate versus ligament reconstruction with fragment fixation.



      3. Type 3:




        • i. Articular fractures



        • ii. Typically nondisplaced



        • iii. Nonoperative treatment:




          • Distal clavicle excision for symptomatic patients.



  2. Allman’s classification:




    1. Distal third:




      1. Group II



      2. 15%.



    2. Middle third:




      1. Group I



      2. 80%.



    3. Medial third:




      1. Group III



      2. 5%.



IV. Imaging




  1. X-rays primary imaging



  2. Compare with contralateral side:




    1. Evaluate for shortening



    2. Zanca view:




      1. 15 degrees cephalad tilt.

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Feb 6, 2021 | Posted by in ORTHOPEDIC | Comments Off on 18 Clavicle Fracture
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