Give parent fracture of the clavicle collarbone fact sheet. Conservative vs operative management of displaced midshaft clavicle fracture. If age 12 years and shortened 2 cm refer to orthopaedics for opinion. Up to 40% of clavicle fractures may remain undetected while the baby is in hospital. Clavicle collar bone fractures are the most common injury sustained by newborns during birth. An exception is a posteriorly displaced medial clavicular fracture, which requires immediate evaluation for concomitant mediastinal andor vascular injuries and pneumothoraces. The course of treatment typically depends on the type of fracture, because some fractures. The shoulder blade scapula is a triangularshaped bone that is protected by a complex system of surrounding muscles. The problem clavicle fractures are common injuries, accounting for 815% of all fractures in children and adults. Figure 102 midshaft clavicle fractures typically result in prominence at the fracture site, which corresponds to the lateral end of the medial fragment. Clavicle collar bone fracture displaced east sussex. Support in a broad arm sling for 3 weeks and provide adequate analgesia advice. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle i. The lateral fragment is usually displaced inferiorly by the weight of the upper extremity 1 and medially by the pull of the latissimus dorsi and pectoralis muscles 2 and the unopposed rotation of the scapula 3.
Management of clavicle fracture in the pediatric population has been debated in recent literature. Management of acute displaced midshaft clavicular fractures. Clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466% of all shoulder fractures 2. Displaced middlethird clavicle fracture management in. Factors that may increase the risk for a clavicle fracture include the newborn being large in size, the newborns shoulder getting stuck during delivery, or the use of tools to assist with the delivery. The history and physical examination remain the primary means of diagnosing this injury. No evidence to support figure of 8 bandage or brace.
Deforming forces on displaced midshaft clavicle fracture. The investigators used an unstable displaced clavicle fracture model under torsional and 3point bending loading. Medical management of displaced midshaft clavicle fractures. Outcomes of operative versus nonoperative treatment of. You may use the arm in the meantime as explained in the protocol and indeed it is important to keep the shoulder moving to prevent stiffness but not to aggravate it.
Epidemiology fracture of the clavicle is the most frequently seen fracture in clinical routine. For torsion and bending, an overall significant difference was found between the 3 types of fixation equipment in terms of failure loads. Introduction clavicle fractures occur commonly, often as a result of indirect or direct trauma to the shoulder region. Classic teaching suggested that even if both ends of the clavicle were widely separated it would go on to heal. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on. Materials and methods the study was done at the tertiary care trauma centre between october 2014 to october 2016.
Nonoperative management of lateral clavicle fractures results in a good outcome in up to 98% of minimally displaced or not displaced fractures while rates increase with displacing of the fractures 4. Clavicle fracture broken collarbone orthoinfo aaos. Type ii injuries are characterized by a medial fragment that is discontinuous with the cc ligaments. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Type ii distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion. Management of type ii distal clavicle fractures has always been a challenge. Because of the high rate of nonunion, neer 4 and others 2,3,6,2345 have advocated primary surgical management of distal clavicle fracture. Robinson, bmedscihons, frcsed investigation performed at the edinburgh shoulder clinic, the royal in. Jan 01, 2008 displaced midshaft clavicle fractures have higher rates of nonunion and a greater risk of longterm sequelae. Scroll down to respond to the orthopaedicsone poll. Nonoperative treatment has a high risk of complications and should be considered only for elderly and frail patients. Several studies have questioned the clinical relevance of distal clavicle nonunion, however. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks.
Surgical treatment of displaced middlethird clavicular fractures. Clinicians working in emergency departments and general clinics should be familiar with the common presentations and complications of this injury, as well as basic management. Fractures of the lateral third of the clavicle were further sub classified by neer, recognizing the importance of the coracoclavicular cc ligaments for the stability of the medial fracture segment. A type i lateral clavicle fracture occurs distal to the cc ligaments, resulting in a minimally displaced fracture that is typically stable. For younger and active patients there is a wide variety of operative options, each with advantages and disadvantages. The timing of surgery for lateralend fractures seems more important for patient outcome when compared with medialthird fractures. Middle third clavicle fractures rarely need reduction. Orif should be the gold standard for management of displaced clavicle fractures in this pointcounterpoint article, drs. Even displaced fractures have been successfully managed without surgery.
Studies have found, however, that in cases of specific fracture patterns and locations, not all clavicle fractures behave the same way. Middle third most common broad arm sling to support limb for 2 weeks or until comfortable. If displaced, the lateral fragment is usually pulled down by weight of limb and the medial fragment tends to be displaced upwards by the action of the sternocleidomastoid muscle. You have sustained a fracture to your clavicle collar bone. Nowac et al conducted a prospective study of 208 cases of clavicle fractures and showed that 46% presented with a functional deficit at the 10year followup. Treatment of an open infected type iib distal clavicle fracture. A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. Non operative management minimally displaced surgical neck 1,2,3 greater tuberosity jan 18, 2012 fractures of the lateral third of the clavicle were further sub classified by neer, recognizing the importance of the coracoclavicular cc ligaments for the stability of the medial fracture segment. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks.
Oct 21, 2011 the third case was a 42 year old man with a displaced fracture of the middle third of his right clavicle, with one large butterfly fragment. However, recent wellconducted studies demonstrate that plate fixation of displaced midshaft clavicle fractures may result in improved functional outcome and a lower rate of malunion and nonunion, compared. Surgical management of displaced midshaft clavicle fracture. Dec 01, 2011 between 70 and 80% of all clavicle fractures are localized to the middle part of the clavicle and of these, most fractures are displaced. This may be explained by significant residual strength deficits following the conservative treatment of these fractures strength deficits ranging from 10% to 35% were found in patients a mean of 54 months after nonoperative care of a displaced fracture of the clavicular shaft16. In children, up to 90% of clavicle fractures are midshaft fractures. Management of acute clavicle fractures sciencedirect. This may be explained by significant residual strength deficits following the conservative treatment of these fractures strength deficits ranging from 10% to 35% were found in patients a mean of 54 months after nonoperative care of a. Forty mid shaft clavicle fractures in adults, displaced with initial shortening of more than 15 mm, were treated with primary internal fixation with plates. Introduction clavicular fractures are a very common fracture in the upper limb accounting for 2. Displaced middle third clavicle fracture fractures requiring orthopaedic referral. Jul 15, 2014 fracture classification allman classification. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it snaps or breaks. Minimally displaced middle third clavicle fracture.
Patients with clavicle fractures complain of marked pain, partic. For displaced middlethird fractures, there were two main methods of surgical fixationopen reduction with plate fixation orif or intramedullary nailing im nail. Risk factors for nonunion after nonoperative treatment of. While conservative treatment of clavicle fractures remains the mainstay of management plans in the majority of cases, recent literature has described incidences up to 31% of. A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. Historically, only unstable distal clavicle fractures were treated operatively. Fracture displacement of less than 100% characterizes subgroup a, whereas fractures displaced by more than 100% account for subgroup b. The majority of clavicle fractures are easily managed with a sling and analgesia. This type of fracture is fairly commonaccounting for about 5 percent of all adult fractures.
Injuries to the sternoclavicular joint and fractures of the medial clavicle may be associated with compression of vital structures within the thorax. Surgical management of distal clavicle fractures is indicated for open fractures, skin compromise, and associated vascular injury requiring surgery. Midshaft clavicle fracture is defined as a fracture in the middle 35 parts of the clavicle lateral boundary is a vertical line from the base of processus coracoideus and medial border is a vertical line. However, because radiographic nonunion does not correlate. The management of clavicle fractures has dramatically changed over the last decade. Surgical management of displaced midshaft clavicle. Scapula fractures represent less than 1% of all broken bones and many of them can be treated without surgery. Severely comminuted or shortened middle third 2 cm if over 12 years of age open fractures. Displaced middlethird clavicle fracture management in sport. In this study, we aimed at elucidatingtheclinical andradiological outcomes betweenthe reconstruction plate and precontoured anatomical locking plate for displaced midshaft clavicle fractures and compared their functional results using quick disability of the. Surgical treatment with open reduction and internal fixation orif of displaced middle third clavicular fractures resulted in shorter complete return.
According to our units experience the first choice could be hook plate fixation. Clavicle fracture an overview sciencedirect topics. Jan 14, 2019 if all clavicle fractures are considered together, the vast majority heal with nonoperative management, which includes use of a simple shoulder sling. Between 70 and 80% of all clavicle fractures are localized to the middle part of the clavicle and of these, most fractures are displaced. Treatment of displaced, midshaft clavicle fractures. In the acute setting, indications for operative management of clavicle fractures include neurovascular compromise, open fractures, gross displacement of fracture. However, complications have been reported after non surgical treatment, the most. N2 fractures of the clavicle are relatively common injuries that can occur in patients of all ages. Surgical management of displaced midshaft clavicle fracture in. Displaced midshaft clavicle fractures may be managed nonoperatively. The fractures he later classified as type ii, in which the fracture occurs medial to the cc ligaments and hence is detached from the displaced medial fragment, had a particularly high. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. Conservative vs operative management of displaced midshaft. Surgical versus nonsurgical management of displaced clavicle.
There has been a shift towards surgical management of displaced midshaft clavicle fractures in adults over last decade. In neers original series of clavicle fractures, he observed the unusually high rate of nonunion in displaced fractures of the lateral third of the clavicle. Surgical versus nonsurgical management of displaced. Fracture of the clavicle is relatively common during a vaginal delivery.
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. In these cases, the medial fragment often exhibits vertical instability after. Intramedullary nailing has proven suitable for simple straight fractures, and plate fixation for multifragmentary fractures. They are caused by direct trauma, falls on the shoulder, or falls onto an. General indications for clavicle operative fracture management include completely dmcf, shortening of over 2 cm, superior displacement resulting in skin threatening and an impending open fracture. Most common approximately 80% in both adults and children.
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