Clavicle Fractures

Question 1

Why do you want a chest xray with clavicle fractures?

Answer 1

To compare the contralteral side

Question 2

What is the management of most clavicle fractures?

Answer 2

NWB sutures out in 2 weeks interval xray at 6 weeks pendulum exercises

Question 3

What is the ossification and fusion history of the clavicle?

Answer 3

The first bone to ossify, the last bone to fuse (fuses at the sternal end age 22-25)

Question 4

Which ligament provides anterior/posterior stability of the shoulder?

Answer 4

AC ligament

Question 5

How far is the trapezoid ligament from the AC joint?

Answer 5

2.5 cm from AC joint

Question 6

How far is the conoid ligament from the AC joint?

Answer 6

3 cm

Question 7

How many pounds of pressure are required to break a clavicle?

Answer 7

7 lbs, this is debatable, recent literature does not agree

Question 8

What is the name of the fracture classification system for clavicles?

Answer 8

Allman classification

Question 9

Where are most clavicle fractures located (lateral, middle, proximal) and what are their percentages?

Answer 9

Middle (80%) Lateral (15%) Medial (5%)

Question 10

what ligaments provide vertical stability to the AC joint?

Answer 10

trapezoid and conoid

Question 11

What structure is at risk with clavicular fractures?

Answer 11

brachial plexus (test distally)

Question 12

what imaging modality is best to determine clavicular dislocation?

Answer 12

CT

Question 13

What is an Allman group I fracture?

Answer 13

fracture of middle third of clavicle

Question 14

What is an Allman group II fracture?

Answer 14

Fracture of the distal third of the clavicle

Question 15

What is an Allman group II Neer type I?

Answer 15

minimal displacement fracture between conoid and trapezoid but still intact without displacement

Question 16

What is an Allman group II Neer type II?

Answer 16

Displaced secondary to a fracture medial to the coracoclavicular ligaments

Question 17

What is important about an Allman group II Neer type II fracture?

Answer 17

higher incidence of nonunion

Question 18

What is an Allman group II Neer type IIA?

Answer 18

conoid and trapezoid attached to the distal segment

Question 19

What is an Allman group II Neer type IIB?

Answer 19

conoid torn, trapezoid attached to the distal segment

Question 20

What is an Allman group II Neer type III?

Answer 20

fracture of the articular surface of the AC joint with no ligamentous injury

Question 21

What is an Allman group II type III fracture often confused with?

Answer 21

AC join separation

Question 22

What is the subclassification system for distal 3rd clavicular fractures?

Answer 22

Neer classification (Type I, II, IIA, IIB, III)

Question 23

What is a Allman Group III fracture?

Answer 23

Fracture of proximal third of clavicle

Question 24

How are Allman Group III fractures further characterized?

Answer 24

Type I: minimally displaced

Type II: Displaced

Type III: Intra-articular

Type IV: Epiphyseal separation

Type V: Comminuted

Question 25

What are the indications for operative treatment of ACUTE clavicle fractures?

Answer 25

open fracture associated neurovascular compromise skin tenting with potential of progression to open fracture

Question 26

Which distal 3rd clavicle fracture type has papers suggesting ORIF?

Answer 26

Type II

Question 27

What are injuries associated with clavicle fractures? (4)

Answer 27

AC injury Scapulothoracic disassociation Floating shoulder Sternoclavicular dislocation

Question 28

How are AC injuries classified?

Answer 28

Rockwood classification

Question 29

What xray view is best to evaluate AC injury?

Answer 29

Zanca view

Question 30

How will a patient with scapulothoracic disassociation present?

Answer 30

clavicle fracture and problems with moving hand

Question 31

What is the cause of a floating shoulder?

Answer 31

Superior suspensory ligamentous complex disruption

Question 32

Which type of sternoclavicular dislocation is managed operatively? Why?

Answer 32

Posterior, because it can injur structures within the mediastinum