Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. 50(6):1096-100. Debski RE, Parsons IM 4th, Woo SL, Fu FH. Benson M, Fixsen J, Macnicol M, Parsch K (Eds). [Medline]. Stiffness is usually not a problem after nonoperative treatment of clavicle fractures. 2nd ed. This study provided level I evidence in support of plate fixation for completely displaced midshaft clavicle fractures in the active adult population. 94(8):675-84. Among the different types of clavicle fractures, those occurring in the middle third of the clavicular shaft are the most common. Content developed by Victorian Paediatric Orthopaedic Network. Laborers may return to light lifting after 6 weeks and full duty at 12 weeks. [33]. 2001 Sep. 51(3):522-5. The first image below illustrates displacing forces; the second image illustrates a type I fracture. Fracture, Clavicle. Most clavicle fractures will heal completely by four months in an adult. StatPearls [Internet]. [Medline]. J Orthop Trauma. 824654-overview Injury. Fractures and minor head injuries: Minor injuries in children II. Complications can include a collection of air in the pleural space surrounding the lung (pneumothorax), injury to the nerves or blood vessels in the area, and an unpleasant appearance. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. [Medline]. The sling is also thought to allow for the return of function of the coracoclavicular ligaments. The clavicle is one of the most commonly fractured bones in the adult population. Author information: (1)Department of Orthopaedics, 1966 Princess Alexandra Hospital , Australia. In Emergency Orthopaedics - The Extremities. [Medline]. Formaini N, Taylor BC, Backes J, Bramwell TJ. 2009 Feb. 91(2):447-60. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. Results of surgical treatment for unstable distal clavicular fractures. It is recommended that the Steinman pin be threaded in the proximal fragment to prevent migration. AU - Pujalte, George Guntur A. Clavicle Fractures 2. Note the medial fragment tenting the skin. [Medline]. J Bone Joint Surg Am. [Medline]. Wick et al reviewed 39 nonunions of midclavicular fractures treated nonoperatively and found a correlation between initial fracture shortening of greater than 2 cm and nonunion. Management of clavicle fractures. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. 74(3):303-7. Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta KappaDisclosure: Nothing to disclose. J Bone Joint Surg Am. The majority of uncomplicated middle third fractures will have excellent functional and cosmetic outcomes. When these patients were then treated with a figure-of-eight brace, union occurred. Regardless of the exact technique used, the general principles of fracture reduction and fixation and stabilization of the coracoclavicular interval apply. BMC Musculoskelet Disord. Open fractures 3. [44] Also included were 2 patients with comminuted distal clavicle fractures. Pediatr Emerg Care. J Bone Joint Surg Br. Clavicle fractures in children (younger than 8 years old) may heal in four or five weeks, and clavicle fractures in adolescents may take six to eight weeks. Khan LA, Bradnock TJ, Scott C, Robinson CM. Once the fracture pain begins to subside and the patient is weaning off pain medications, begin range-of-motion exercises with the shoulder and elbow out of the sling to prevent stiffening of these joints. Neer CS. The use of Wolter clavicular plates for unstable, comminuted distal clavicle fractures was reported to result in good bony union and range of motion in all 16 patients in a series by Mizue et al. Injuries are usually the result of a fall on an outstretched hand with the force transmitted up the arm. Please confirm that you would like to log out of Medscape. Fatal subclavian artery transection from isolated clavicle fracture. The majority of clavicle fractures are managed with analgesia and a broad arm sling B) The posterior dislocation (red arrow) is more evident on CT scan. 2007 Jun. Clavicle fractures. Jeray KJ. Clin Orthop Relat Res. Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin Gullo J, Singletary EM, Larese S. Emergency bedside sonographic diagnosis of subclavian artery pseudoaneurysm with brachial plexopathy after clavicle fracture. 17(3):395-8. Many articles have been published focusing on the treatment of distal third clavicle fractures. Repeat x-rays are usually not required. [Medline]. Chien M, Bulloch B, Garcia-Filion P, Youssfi M, Shrader MW, Segal LS. Return to contact sports takes much longer because the risk of refracture is high. Significant displacement is rare because of the extensive ligamentous attachments. 2018 Jan. [Medline]. Skin at risk over fracture 6. Acta Orthop Belg. - distal clavicle fractures may have a high incidence of non union but most of these are asymptomatic, and of these ... Risk Management Programs, Continuing Education and Association Management. These milestones are usually reached at about 6 weeks from the time of the injury. Current management of medial clavicle fractures remains nonoperative, including with ice, analgesics, and a sling for support, and the treatment results have been consistently good. Obtaining purchase in 6 cortices on either side of the fracture is recommended. [Full Text]. Nerve palsies and vascular injuries are rare with isolated fractures but may be present in the presence of Polytrauma or ipsilateral humerus fractures. CD007121. [45] This procedure, however, requires a second operation for removal of the plate and is recommended only for injuries that are severely comminuted and unstable. 3:25. When using plate-and-screw fixation to treat clavicle fractures, the surgeon must remember that the hardware will likely be prominent. [24]. Clavicular fractures in adults. The clavicle is one of the most common fractured bones in children. Operative treatment is best suited for more complicated fractures of the middle third of the clavicle. Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. [Medline]. Hill JM, McGuire MH, Crosby LA. Figure 3:  A) 14 year old with posterior dislocation of the medial end of right clavicle. Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope. J Bone Joint Surg Am. Kao et al reported on an operative technique with which 11 of 12 fractures formed bony unions, with these patients experiencing pain-free range of motion. 2007 Apr. Pain at the clavicle or top of … As pain continues to improve, isometric exercises of the shoulder girdle and arm musculature can begin. 2011 Nov. 27(11):1038-41. [Medline]. 2001 Jun. Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. The wire fixation and the Mersilene tape provide stability for the fracture, allowing the repaired coracoclavicular ligament to heal. Emergency Orthopedics: The Extremities. Displaced lateral third fractures 7. The periosteum is then stripped to expose and reduce the fracture, after which plate-and-screw fixation is performed using any of a wide variety of plates. Open reduction and internal fixation of these injuries is recommended for patients with displaced middle third clavicle fractures with greater than 2 cm of shortening. Nonoperative management remains the most common approach to nondisplaced midshaft clavicle fractures. [Full Text]. Curr Sports Med Rep. 2008 Sep-Oct. 7(5):275-80. Cochrane Database Syst Rev 2009; CD007121. Kendall KM, Burton JH, Cushing B. With some clavicle fractures, however, the pieces of bone move far out of place when the injury occurs. In all other situations not presenting as a surgical emergency, the primary goal in the management of clavicle fractures is to achieve bony union with as little or no residual pain, dysfunction, or cosmetic deformity. Evidence is mounting, however, in support of operative treatment for displaced midshaft clavicle fractures. For many decades, the results of nonsurgical treatment found that the majority of clavicle fractures healed more reliably with less of a complication rate when compared to clavicle fractures treated with surgery. J Shoulder Elbow Surg. The intact ligaments hold the fragments in place. [Medline]. Your clavicle, or your collar bone, goes from the top of your breastbone to your shoulder blade, so a fracture can cause an intense amount of pain in your upper body. A prospective study during a two-year period in Uppsala, Sweden. Additionally, functional outcomes were improved at all time points measured in the operative group. Although the figure-of-eight dressing is still widely used, several studies have demonstrated similar union rates and increased satisfaction in patients treated with a simple arm sling.10,11 The figure-of-eight dressing may cause dis… A long term functional outcome study. It is the most common perinatal fracture associated with birth trauma. 3. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. McKerrow M(1), North J(1). See fracture clinics for other potential complications. Distal clavicle fracture — this occurs in approximately twenty percent of clavicle fractures and occurs in close proximity to the end of your clavicle at your shoulder joint Medial clavicle fracture — this occurs in approximately five percent of clavicle fractures and often has a relationship to injury to your sternoclavicular joint , which is the connection of your sternum to your clavicle. [Medline]. All of the patients subsequently developed bony union of the fracture site with full range of motion. Traditionally, these fractures have been treated nonsurgically. [Medline]. 5th Ed. Clavicle fracture is one of the most common birth injuries of a newborn. When a midshaft clavicle fracture requires surgical fixation, the commonly performed involves open reduction of the fracture, followed by either insertion of an intramedullary device or fixation with a plate and screws. [Medline]. These treatment options are applicable for almost all middle third clavicle fractures, with the exception of those that are severely displaced or shortened. [31] Healing time may be as short as 2 weeks for infants, with most adults healing in 4-6 weeks. [5], Polytrauma (with multiple fractures): To expedite rehabilitation, An inability to tolerate closed treatment. Neer found that although distal third clavicle fractures are rare, they account for approximately half of all clavicular nonunions. However, if significant displacement occurs with this fracture, further imaging studies are warranted. J Trauma. Fractures of the middle third (midshaft) account for 69 to 82.4% of all clavicular fractures.13,14 Conservative management was the usual mode of treatment for midshaft fractures even when displaced, due to the false belief that non-unions are … The vast majority of clavicle fractures heal with nonoperative management, which includes the use of a simple shoulder sling. All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. The study included 7 patients with displaced type IIA fractures and 3 patients with type IIB fractures; all of them underwent open reduction and internal fixation with Kirschner wires (K-wires) and a tension band. Pathological fracturesCongenital pseudoathrosis of clavicle - multiple previous fractures in same location [Medline]. A type IIB fracture of the distal clavicle. Kao et al's technique spared the soft tissue around the fracture site, including the AC joint, with dissection limited only to the fracture site. Neurovascular injury with fracture 5. After the fracture is visualized and reduced, the coracoclavicular interval is stabilized. To provide feedback, please email. Type II fractures are depicted in the images below. Demirhan M, Bilsel K, Atalar AC, Bozdag E, Sunbuloglu E, Kale A. Biomechanical comparison of fixation techniques in midshaft clavicular fractures. 2002 Superior versus anteroinferior plating of clavicle fractures. BET 2: Can ultrasound be used to diagnose clavicle fractures in children?. These fractures are usually minimally displaced or nondisplaced and are treated nonoperatively, as previously described. Support the weight of the arm in a triangular sling, and give an analgesic such as paracetamol/codeine preparations, or NSAIDs. Factors that may increase the risk for a clavicle fracture include the newborn being large in size, the newborn’s shoulder getting stuck during delivery, or the use of tools to assist with the delivery. 36(7):e898-904. Both non-operative and surgical methods have been described for the management of this injury. Chalidis B, Sachinis N, Samoladas E, Dimitriou C, Christodoulou A, Pournaras J. 2013 Jul 3. Displaced lateral and medial third fractures require orthopedic referral for assessment. Pujalte GG, Housner JA. The literature, however, shows no real difference in outcomes between patients treated with a figure-of-eight splint versus a sling, so the choice of immobilization should depend on the comfort and functional demands of the patient. Ann Emerg Med. Clavicle fractures: individualizing treatment for fracture type. Cochrane Database Syst Rev. Additional view of fracture displacement and comminution in a hockey player. Young SJ, Barnett PL, Oakley EA. Acad Emerg Med. Grassi et al found that patients treated nonoperatively for uncomplicated midclavicle fractures recovered more quickly than did those who were treated operatively. Most clavicle fractures can be treated by wearing a sling to keep the arm and shoulder from moving while the bone heals. [4], Displaced medial clavicular fractures with mediastinal structures at risk Procedures, 2002 2012 Apr 18. Emerg Med J. [41]. The majority of clavicle fractures are easily managed with a sling and analgesia. 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