Clavicle # - TM

Question 1

Clavicle fracture classification

Answer 1

• Allman - determined by anatomical location

Question 2

Allman classifcation

Answer 2

• Type I- middle third of clavicle (75% of #, weakest segment) - stable, but significant deformity
• Type II - lateral third (20%) when displaced, unstable
• Type III - medial clavicle (5%) - associated with multisystem polytrauma, can have NV pneumo/haemothroax due to proximity

Question 3

Pathophys of clavicle #

Answer 3

• Often due to direct trauma or indirect eg fall onto shoulder
• Medial fragment displace superiorly - pull of SCM
• Lateral fragment displace inferiorly - weight of arm

Question 4

Complication of clavicle #

Answer 4

• Subcutaenous location of clavicle = check for open injuries or threatened skin
• Threatened if appears tented, tethered, white and non blanching
• Check NV status - brachial plexus injury?
• Surgical emphysema - pneumothorax too?

Question 5

Management clavicular #

Answer 5

• Conservative - no benefit to surgery, metalwork often prominent due to it being SC
• Sling - elbow well supported
• Early movement of shoulder joint - prevent frozen shoulder
• Sling kept on until pain free movement of shoulder

BUT patients should be given choice if want surgery, quicker union time may outweight risk in some people eg if self employed

Question 6

When is surgery done for clavicle #

Answer 6

• ALL open # anyway
• Very comminuted OR
• Very shortened OR
• If bilateral to permit weight bearing OR
• Failure to unite - ORIF 2-3 months post injury

Question 7

Healing time clavicle #

Answer 7

4-6 weeks