[40] Clavicle Fracture

Question 1

Who do clavicle fractures commonly occur in?

Answer 1

Adolescents and young adults

Second peak of incidence over age of 60

Question 2

What are the categories of causes of clavicle fracture?

Answer 2

• Direct

- Indirect

Question 3

What are the direct causes of clavicle fracture?

Answer 3

Trauma directly onto clavicle

Question 4

What are the indirect causes of clavicle fracture?

Answer 4

Fall onto shoulder

Question 5

What will often happen to the clavicle once it is fractured, in terms of displacement?

Answer 5

The medial fragment will often displace superiorly, whilst the lateral fragment will displace inferiorly

Question 6

Why will the medial fragment of the clavicle often displace superiorly?

Answer 6

Due to pull of sternocleidomastoid muscle

Question 7

Why will the lateral fragment of the clavicle often displace inferiorly?

Answer 7

Due to weight from arm

Question 8

How do patients with clavicle fractures present?

Answer 8

Sudden-onset localised severe pain, made worse on active movement of the arm, nearly always following trauma

Question 9

What is found on examination in clavicle fracture?

Answer 9

Focal tenderness with deformity and mobility at fracture site

Question 10

What is it important to look for on examination of clavicle fracture?

Answer 10

• Open injuries or threatened skin

- Neuromuscular status of upper limb

Question 11

How does threatened skin look in clavicle fracture?

Answer 11

Tented, tethered, white, non-blending

Question 12

Why is it essential threatened skin is recognised in clavicle fracture?

Answer 12

Implies impending conversion to open injury

Question 13

Why is it important to assess the neuromuscular status of upper limb in clavicle fracture?

Answer 13

Due to propensity for brachial plexus injuries following clavicle fracture

Question 14

What are the differentials for clavicle fracture?

Answer 14

• Sternoclavicular dislocation

- Acromioclavicular joint seperation

Question 15

What x-rays should be done in clavicle fracture?

Answer 15

Plain film anteroposterior and modified-axial radiographs

Question 16

When might CT be needed in clavicle fracture?

Answer 16

Rarely indicated, but may be needed to assess medial clavicle injuries

Question 17

How can most clavicle fractures be treated?

Answer 17

Conservatively

Question 18

Why are most clavicle fractures treated conservatively?

Answer 18

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

Question 19

What is involved in the conservative management of clavicle fracture?

Answer 19

Sling

Question 20

How do you know a sling is properly applied in clavicle fracture?

Answer 20

So elbow is well supported and improves deformity

Question 21

What is recommended following sling in clavicle fracture?

Answer 21

Early movement of shoulder joint

Question 22

Why is early movement of shoulder joint recommended in clavicle fracture?

Answer 22

To prevent development of frozen shoulder

Question 23

How long is the sling kept on in clavicle fracture?

Answer 23

Until patient regains pain-free movement of the shoulder

Question 24

What clavicle fractures require surgical intervention?

Answer 24

• Open
• Very comminuted fractures
• Very shortened fractures
• Bilateral fractures

Question 25

What is a major complication of clavicle fractures?

Answer 25

Non-union

Question 26

What are the other important complications of clavicle fractures?

Answer 26

• Neuromuscular injury

- Puncture injury, e.g. pneumothorax, haemothorax

Question 27

What is the healing time for most clavicular fractures in adults?

Answer 27

4-6 weeks