Clavicle Fractures

Question 1

MC location

Answer 1

• middle 1/3rd

Question 2

Last ossification center during development?

Answer 2

• sternal end of clavicle

- age 22-25

Question 3

What does the medial 1/3rd protect?

Answer 3

• brachial plexus
• subclavian & axillary vessels
• superior lung

Question 4

Components of the coracoclavicular (CC) ligament

Answer 4

• trapezoid

- conoid

Question 5

Function of CC lig

Answer 5

• vertical stability to AC jt

Question 6

MOI

Answer 6

• fall onto affected shoulder (MC)
• direct impact
• FOOSH
• M. contraction (i.e. seizures)
• pathologic bone

Question 7

Body positioning during eval

Answer 7

• adducted and supported by contralateral arm to unload shoulder

Question 8

Eval components

Answer 8

• neurovascular: eval elements lying post. to clavicle
• integumentary: proximal end of fx tents skin –> r/o open fx
• pulm: dim breath sounds –> ? ipsilat PTX 2/2 apical lung injury

Question 9

MC fx a/w clavicle fx

Answer 9

• rib

Question 10

What is a/w prox 1/3rd clav fx?

Answer 10

• brachial plexus injury 2/2 traction

Question 11

XR views

Answer 11

• AP
• 30 deg cephalad (remove overlapping thoracic anatomy)
• apical oblique (for min displaced fx, esp in pedi)
• CXR for comp B

Question 12

Why order CT?

Answer 12

• prox 1/3rd fx: differentiate SC disloc v. epiphyseal injury
• dist. 1/3rd fx: eval articular involvement

Question 13

Define Group I

Answer 13

• middle 1/3rd fx

Question 14

Define Group II

Answer 14

• distal 1/3rd fx, further described by type

Question 15

Group II Type I

Answer 15

• min displacement 2/2 inter-ligamentous fx, either b/t conoid & trapezoid or CC & AC

Question 16

Group II Type II

Answer 16

• displaced 2/2 fx med to CC lig

Question 17

Group II Type IIA

Answer 17

• conoid & trapezoid attached to distal frag

Question 18

Group II Type IIB

Answer 18

• conoid torn, trapezoid attached to distal frag

Question 19

Group II Type III

Answer 19

• intra-articular fx to ACJt

- no ligamentous injury

Question 20

Group III

Answer 20

• prox 1/3rd fx

Question 21

Non-op tx

Answer 21

• immob x 4-6w
• AROM elbow, wrist, fingers
• serial XR

Question 22

Op techniques

Answer 22

• plate & screws

- IM fixation (Hagie pin, Rockwood pin, Sonomal nail)

Question 23

Complications

Answer 23

• NV compromise: uncommon
• malunion
• nonunion: 2/2 severity of initial trx (open), extent of initial displacement of fx frags, soft tissue interposition, refx, inad immob length, primary ORIF
• post-trx arthritis: intra-articular to SC and AC jts