Clavicle Fracture Flashcards
Who is commonly affected by clavicle fractures?
They most commonly occur in adolescents and young adults, however a second peak in incidence also occurs over the age of 60, associated with the onset of osteoporosis.
Briefly describe the Allman Classification System
Clavicular fractures can be classified by the Allman classification system, determined by the anatomical location of the fracture along the clavicle:
- Type I: fracture of the middle third of the clavicle (75%)
- Type II: fractures involving the lateral third of the clavicle (20%)
- Type III: fracture involving the medial third of the clavicle (5%)
Which part of the clavicle is the weakest?
Middle 1/3rd.
Briefly describe the pathophysiology of clavicle fractures
Clavicle fractures will occur through either a direct (trauma directly onto the clavicle) or indirect (such as a fall onto the shoulder) mechanism of injury.
The medial fragment will often displace superiorly, due to the pull of the sternocleidomastoid muscle, whilst the lateral fragment will displace inferiorly from the weight of the arm.
What are the clinical features of clavicle fractures?
Patients will present with sudden-onset localised severe pain, made worse on active movement of the arm, nearly always following trauma. On examination, there will be focal tenderness, with deformity and mobility at the fracture site.
Due to the subcutaneous location of the clavicle, it is important to specifically look for open injuries or threatened skin.
Ensure to check neurovascular status of the upper limb, given the propensity for brachial plexus injuries following a clavicle fracture.
What investigations should be ordered for clavicle fractures?
Plain film anteroposterior and modified-axial radiographs of the affected clavicle should be performed, allowing any displacement to be fully assessed.
CT imaging is rarely indicated, but may be needed to assess medial clavicle injuries, which can be difficult to fully assess on plain radiographs.
Briefly describe the conservative management of clavicle fractures
Most clavicle fractures can be treated conservatively, even those with significant deformity, as evidence has shown no long-term benefit to surgical management over a conservative approach, with >90% uniting despite displacement.
Initial treatment is with a sling, which should be properly applied so that the elbow is well supported and improves the deformity. Early movement of the shoulder joint is recommended, to prevent the development of frozen shoulder in these patients. The sling is generally kept on until the patient regains pain-free movement of the shoulder.
Briefly describe the surgical management of clavicle fractures
Open fractures will need surgical intervention.
However, surgical management for the remainder of clavicle fractures remains contentious. It is usually reserved for very comminuted fractures or those that are very shortened. It is also typically performed if the patient has bilateral fractures, to permit weight bearing.
Where fractures have failed to unite, an ORIF will be necessary, which is usually performed at 2-3 months post-injury.
Briefly describe what is shown on the x-ray
Plain radiograph of clavicular fracture fixed with a pin
What are the common complications of clavicle fractures?
Non-union is a major complication of clavicle fractures, most associated with a distal third clavicular fractures.
Other important complications to assess for include neurovascular injury and any puncture injury (haemothorax or pneumothorax).
How long is the healing time for clavicle fractures?
4-6 weeks.
What differentials should be considered for clavicle fractures?
Whilst the diagnosis is often apparent, differentials to consider include sternoclavicular dislocation and acromioclavicular joint (ACJ) separation.
