FRACTURES OF THE CLAVICLE
In adults clavicle fractures are common, accounting
for 2.6 per cent of fractures and approximately 35 per
cent of all shoulder girdle injuries
-Mechanism of injury
A fall on the shoulder or the outstretched hand may
break the clavicle.
-In the common mid-shaft fracture,
the outer fragment is pulled down by the weight of
the arm and the inner half is held up by the sternomastoid
muscle.
In fractures of the outer end, if the
ligaments are intact there is little displacement; but if
the coracoclavicular ligaments are torn, or if the fracture
is just medial to these ligaments, displacement
may be severe and closed reduction impossible
-Clinical features
-The arm is clasped to the chest to prevent movement.
A subcutaneous lump may be obvious and occasionally
a sharp fragment threatens the skin
-Imaging-an anteroposterior
view and another taken with a 30 degree cephalic
tilt.
Classification:-based on their location.
Group I (middle third fractures),
Group II (lateral third fractures) and Group III
(medial third fractures)
Treatment,
MIDDLE THIRD FRACTURES
There is general agreement that undisplaced fractures
should be treated non- operatively.
Non-operative management consists of applying a
simple sling for comfort.
-It is discarded once the pain
subsides (between 1-3 weeks) and the patient is then
encouraged to mobilize the limb as pain allows the skin.
LATERAL THIRD FRACTURES
Most lateral clavicle fractures are minimally displaced
and extra-articularactures)
-The fact that the coracoclavicular
ligaments are intact prevents further displacement and
non-operative management is usually appropriate.
Treatment consists of a sling for 2�3 weeks until the
pain subsides, followed by mobilization within the
limits of pain.
Displaced lateral third fractures:-Surgery to stabilize the fracture is often recommended
MEDIAL THIRD FRACTURES
rare fractures are extra-articular
managed non-operatively unless the fracture displacement threatens the mediastinal structures.
Complications:-
EARLY
proximity of the clavicle to vital
structures, a pneumothorax, damage to the subclavian
vessels and brachial plexus injuries are all very rare.
LATE
Non-union In displaced fractures of the shaft-
Risk factors include increasing
age, displacement, comminution and female
sex
-Symptomatic non-unions are generally treated with
plate fixation and bone grafting structures.
-Lateral clavicle fractures have a higher rate of nonunion:-internal
fixation and bone grafting if the fragment is
large. Locking plates and hooked plates are used.
Malunion :-All displaced fractures heal in a non anatomical
position with some shortening and
angulation, however most do not produce symptoms.
Fracture of the outer (lateral) third :- This was
treated by open reduction and internal fixation, using a
long screw to fix the clavicle to the coracoid process temporarily
while the soft tissues healed.
The shaft of the clavicle is elevated, suggesting that the medial part
of the coracoclavicular ligament is ruptured.
open reduction and internal fixation
Displaced fracture of the middle third of the clavicle the most common injury
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