[40] Clavicle Fracture Flashcards
Who do clavicle fractures commonly occur in?
Adolescents and young adults
Second peak of incidence over age of 60
What are the categories of causes of clavicle fracture?
- Direct
- Indirect
What are the direct causes of clavicle fracture?
Trauma directly onto clavicle
What are the indirect causes of clavicle fracture?
Fall onto shoulder
What will often happen to the clavicle once it is fractured, in terms of displacement?
The medial fragment will often displace superiorly, whilst the lateral fragment will displace inferiorly
Why will the medial fragment of the clavicle often displace superiorly?
Due to pull of sternocleidomastoid muscle
Why will the lateral fragment of the clavicle often displace inferiorly?
Due to weight from arm
How do patients with clavicle fractures present?
Sudden-onset localised severe pain, made worse on active movement of the arm, nearly always following trauma
What is found on examination in clavicle fracture?
Focal tenderness with deformity and mobility at fracture site
What is it important to look for on examination of clavicle fracture?
- Open injuries or threatened skin
- Neuromuscular status of upper limb
How does threatened skin look in clavicle fracture?
Tented, tethered, white, non-blending
Why is it essential threatened skin is recognised in clavicle fracture?
Implies impending conversion to open injury
Why is it important to assess the neuromuscular status of upper limb in clavicle fracture?
Due to propensity for brachial plexus injuries following clavicle fracture
What are the differentials for clavicle fracture?
- Sternoclavicular dislocation
- Acromioclavicular joint seperation
What x-rays should be done in clavicle fracture?
Plain film anteroposterior and modified-axial radiographs
When might CT be needed in clavicle fracture?
Rarely indicated, but may be needed to assess medial clavicle injuries
How can most clavicle fractures be treated?
Conservatively
Why are most clavicle fractures treated conservatively?
Evidence has shown no-long term benefit to surgical management
As clavicle is subcutaneous, metalwork often more prominent and therefore requires removal after fracture union
What is involved in the conservative management of clavicle fracture?
Sling
How do you know a sling is properly applied in clavicle fracture?
So elbow is well supported and improves deformity
What is recommended following sling in clavicle fracture?
Early movement of shoulder joint
Why is early movement of shoulder joint recommended in clavicle fracture?
To prevent development of frozen shoulder
How long is the sling kept on in clavicle fracture?
Until patient regains pain-free movement of the shoulder
What clavicle fractures require surgical intervention?
- Open
- Very comminuted fractures
- Very shortened fractures
- Bilateral fractures
What is a major complication of clavicle fractures?
Non-union
What are the other important complications of clavicle fractures?
- Neuromuscular injury
- Puncture injury, e.g. pneumothorax, haemothorax
What is the healing time for most clavicular fractures in adults?
4-6 weeks
