Clavicle fracture account for approximately 5% of adult fractures and there continues to be controversy in the ideal treatment.
18 Clavicle Fracture
Young active patients
Sternocleidomastoid (SCM): Pulls medial fragment posteromedially.
Weight of arm and pectoralis pull lateral fragment inferomedially.
Open fractures → fragment buttonholes through the platysma.
Associated injuries are rare but include:
Ipsilateral scapular fracture
Lateral 1/3 fractures can have concomitant glenohumeral pathology.
“S” shape with six muscular attachments
Acts as a strut connecting the axial and appendicular skeleton
Sternoclavicular joint medially
Acromioclavicular joint laterally
The first bone to start ossification and the last one to complete union.
Middle Third (Group 1):
i. <100% displacement.
i. >100% displaced.
Lateral third (Group 2):
ii. Fractures occur between the acromioclavicular (AC) and coracoclavicular (CC) ligaments and ligaments are intact
iii. Treatment is nonoperative.
CC ligaments attached to distal fragment.
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.
i. Articular fractures
ii. Typically nondisplaced
iii. Nonoperative treatment:
Distal clavicle excision for symptomatic patients.
X-rays primary imaging
Compare with contralateral side:
Evaluate for shortening
15 degrees cephalad tilt.