Clavicle Fracture Flashcards
Epidemiology of clavicle fractures.
Account for around 3% of fractures which makes them common.
Most common in adolescents and young adult but there is second peak in incidence in over 60s due to onset of Osteoporosis.
Classification of Clavicular fractures
Allman classification system
Explain Allman classification system.
Classified by the anatomical location of the fracture along the clavicle.
Type 1 - Fracture of middle third (75%) because it is the weakest segment.
Generally stable but can cause deformity.
Type 2 - Fracture of lateral third (20%).
If displaced they are often unstable.
Type 3 - Fracture of medial third (5%) and associated with multi-system polytrauma.
Can also cause neurovascular compromise, pneumothorax and haemothorax as the mediastinum sits directly behind.
Mechanism of injury of clavicular fracture.
Direct trauma
Indirect trauma (fall onto shoulder)
Medial fragment will often displace superiorly due to pull of SCM while lateral fragment will displace inferiorly from weight of arm.
Clinical features of clavicle fracture
Sudden-onset localised severe pain that is worse on active movement of arm.
Examination findings
Focal tenderness + deformity + mobility at fracture site.
What else should you look for on examination?
Due to subcutaneous location of clavicle you should check for open injuries or threatened skin.
Threatened skin appear as tented, tether, white and non-blanching skin.
Also check neurovascular status of upper limb as brachial plexus injuries can happen.
Dx
Diagnosis is often apparent
But sternoclavicular dislocation and acromioclavicular joint separation can look similar.
Investigations
Plain film anteroposterior and modified-axial radiographs to assess any possible displacement.
CT is rarely needed but can be done to assess medial clavicle injuries.
Types of management of clavicle fractures
Conservative
Surgical
Indications of conservative management
The majority are treated conservatively even if there is significant deformity as evidence show no long-term benefit to surgical management since >90% unite despite displacement.
Also because the clavicle is subcut, metalwork is often prominent and requires removal after fracture union.
Conservative management
Sling that should support the elbow and improve the deformity.
Early movement of the shoulder joint is recommended to prevent development of frozen shoulder in these patients.
Sling is generally kept on until the patient regains pain-free movement.
Indications for surgical management.
Open fractures
Very comminuted fractures
Bilateral fractures to permit weight bearing.
Surgical management of clavicle fractures.
Where fractures fail to unite ORIF will be necessary.
Should be performed at 2-3 months post-injury
Prognosis & Complications
Non-union mostly associated with distal third fractures.
Neurovascular injury and haemothorax/pneumothorax.
Healing time is around 4-6 weeks usually.
