Clavicle fracture Flashcards
Are they common injuries?
Yes - accounting for around 3% of all fractures
Who do they most commonly occur in?
Adolescents and young adults
Second peak: over 60 with onset of osteoporosis
What system can be used to classify them?
Allman classification
Describe the Allman system
Type I
- fracture of the middle third (75%)
- generally stable, although significant deformity usually present
Type II
- fracture involving the lateral third (20%)
- When displaced they are often unstable
Type III
- Medial third (5%)
- commonly associated with multi system polytrauma
- mediastinum sits directly behind, so can be associated neurovascular compromise, pneumothorax or haemothorax
How do they typically occur?
Direct trauma onto the clavicle
Indirect mechanism of injury e.g fall onto the shoulder
Why does the medial fragment often displace superiorly?
Due to pull of sternocleidomastoid muscle
Describe the clinical features
Sudden onset, localised, severe pain made worse on active movement of arm
What is found on examination?
Focal tenderness
Deformity and mobility at fracture site
Look for open injuries or threatened skin - tented, white, non blanching skin
Why is it important to recognise threatened skin?
Implies impending conversion to an open injury
What neurovascular injury can occur?
Brachial plexus injury
Aortic arch injury
What investigations should be done?
Plain film anteroposterior and modified axial radiographs
CT imaging rarely indicated
How is it managed?
Most treated conservatively even those with significant deformity - >90% unite despite displacement
Initial treatment = sling with elbow well supported to improve deformity
Early movement of shoulder joint recommended
Keep sling on until pain free movement achieved
Do open fractures need surgical intervention?
Yes
When is surgery done?
Open fracture
Very comminuted or very shortened
Bilateral
How long do they typically take to heal?
4-6 weeks
