Clavicle Fracture

Question 1

What is the peak age of incidence of clavicular fractures?

Answer 1

Adolescents and young adults, with another peak of over 60s associated with onset of osteoporosis

Question 2

How are clavicular fractures classified?

Answer 2

Allman classification system, determined by anatomical location of fracture along the clavicle

Type 1 - middle 1/3rd (weakest segment, generally stable)

Type 2 - lateral 1/3rd (unstable fracture)

Type 3 - medial 3rd, associated with multi system polytauma. As anterior to mediastinum, can get neurovascular compromise, pneumothorax or haemothorax

Question 3

What is the pathophysiology of clavicle fractures?

Answer 3

Direct trauma to clavicle or indirect e.g fall onto shoulder

Medial fragment will move upwards due to role of sternocleidomastoid muscle and lateral fragment will move inferiorly from weight of arm

Question 4

What are the clinical features of clavicular fractures?

Answer 4

Sudden onset localised severe pain, made worse by active movement of arm after trauma

Focal tenderness with deformity and mobility at fracture site

Potential open injuries or threatened skin (tented, tethered white and non blanching)

Check neurovascular status and brachial plexus lies nearby

Question 5

What investigations can be done for clavicular fractures?

Answer 5

Plain film anteroposterior and modified axial radiographs of clavicle to asses displacement

If suspected medial clavicle fracture CT may be useful as can be hard to see on plain radiographs

Question 6

How are clavicular fractures managed?

Answer 6

Conservatively usually

Initially, sling so elbow is well supported to improve deformity. Early movement of shoulder is encouraged to avoid frozen shoulder.
Use sling until pain free movement of shoulder.

Question 7

When will clavicular fractures need surgery?

Answer 7

Open fractures

Rest of clavicle, usually surgery is reserved for comminuted fractures or very shortened, also if patient has bilateral fractures to allow weight bearing

Open reduction/internal fixation (implementation of implants for bone repair) can be done if fractures fail to unite, usually done 2-3 months post injury

Question 8

What is the prognosis for clavicular fractures?

Answer 8

Non malunion = main issue and major complication, associated with distal 1/3rd fractures

Need to asses for neurovascular injury and puncture injury in medial third injuries

Healing time in adults is 4-6 weeks