Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. . This is difficult to see on x-ray. Results of a survey at German trauma departments]. The fracture is fixed with a number 7 or smaller steel wire. 2012 Jul. INTRODUCTION. [Medline]. Mehmet et al conducted an evaluation of the biomechanical properties and the stability of a locking clavicle plate (LCP), a dynamic compression plate (DCP), and an external fixator (Ex-fix) and found significant differences between them. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. [Medline]. Clavicle fractures 1. J Bone Joint Surg Am. 1994 Mar. 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. The sling is also thought to allow for the return of function of the coracoclavicular ligaments. Fractures of the clavicle can be classified by its anatomical location (Table 1): Table 1: Classification of clavicle fractures by location. Grassi et al found that patients treated nonoperatively for uncomplicated midclavicle fractures recovered more quickly than did those who were treated operatively. [Medline]. Additional x-ray views increase decision to treat clavicular fractures … Overall, however, patients in both groups were satisfied with their results, although 35% of the surgical group had some adverse events during their recovery, most of which were minor. See also: Clavicle fractures - Fracture clinics, Broad arm sling to support limb for 2 weeks or until comfortable. Pain from the fracture and restriction of movement are usual for 2-3 weeks and will require regular analgesia.  Healing time may be as short as 2 weeks for infants, with most adults healing in 4-6 weeks. Nonunion of the clavicle. For clavicle fractures managed non-operatively, the sling-and-swathe or figure-of-eight splints remain appropriate options. Regardless of the exact technique used, the general principles of fracture reduction and fixation and stabilization of the coracoclavicular interval apply. 2009 Feb. 23(2):106-12. Clavicle fractures. [Medline]. Additionally, functional outcomes were improved at all time points measured in the operative group. Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. Mueller M, Burger C, Florczyk A, Striepens N, Rangger C. Elastic stable intramedullary nailing of midclavicular fractures in adults: 32 patients followed for 1-5 years. [Medline]. The majority of clavicle fractures are easily managed with a sling and analgesia. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. The focus of treatment of middle third fractures remains nonoperative. Results of surgical treatment for unstable distal clavicular fractures. Patients with the following injuries should be sent to a surgeon to determine if operative intervention is necessary: Complete fracture displacement  : A literature review showed that 15% of displaced midshaft clavicular fractures went on to nonunion when treated nonoperatively J Trauma. Fractures and minor head injuries: Minor injuries in children II. Acta Orthop. [Medline]. 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. When is reduction (non operative and operative) required? Management of acute clavicle fractures. Neer CS 2nd. With some clavicle fractures, however, the pieces of bone move far out of place when the injury occurs. [Medline]. Many techniques of surgical fixation of distal clavicle fractures have been described in the literature. Recommendations vary from semitubular plates to dynamic compression plates, low-contact dynamic compression plates, and double plating. However, this data needs to be interpreted with caution since 3 additional players never returned to play and 3 others did not return to play for an entire season and all 6 players were excluded from the performance analysis. Benson M, Fixsen J, Macnicol M, Parsch K (Eds). Checchia SL, Doneux PS, Miyazaki AN, Fregoneze M, Silva LA. Orthop Clin North Am. Fractures of the medial third are usually the result of direct trauma to the anterior chest (such as in a motor vehicle accident), and can be associated with neurovascular, pulmonary and cardiac (rare) injuries. 2nd ed. Immobilization should continue until repeat radiographs show callus formation and healing across the fracture site. . Concomitant glenoid neck fracture (floating shoulder). As pain continues to improve, isometric exercises of the shoulder girdle and arm musculature can begin. These milestones are usually reached at about 6 weeks from the time of the injury. 2002 Comparison of both clavicles, with the left tenting the skin (wide arrow). Y1 - 2008/1/1. 2013 Jul 3. Repeat x-rays are usually not required. Severely comminuted or shortened middle third (>2 cm if over 12 years of age) 2. [Medline]. These can be performed under the supervision of a physical therapist or by the patient on his or her own, with an instructional handout for guidance. A direct blow to the outer end of the clavicle (such as a fall onto the point of the shoulder during sporting activities or a striking injury) can be associated with distal third injuries and acromioclavicular joint disruption. In Emergency Orthopaedics - The Extremities. The advantage of the figure-of-eight brace is that it gives patients the ability to use both hands. Acta Orthop. 95(13):1153-8. All fractures should be assessed using the Advanced Trauma Life Support (ATLS) principles to ensure associated and potentially significant injuries are identified. 2007 Jan. 89(1):1-10. 1997 Jul. Four other patients included in this study were previously diagnosed as having established nonunions. Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope. Huang JI, Toogood P, Chen MR, Wilber JH, Cooperman DR. Clavicular anatomy and the applicability of precontoured plates. J Shoulder Elbow Surg. Cancellous bone grafting is indicated in cases of comminution and/or bone loss. The proximal fragment is displaced. Displaced medial clavicular fractures with mediastinal structures at risk[… Clavicle fracture- MANAGEMENT BY M J FELIX EMERSON 2. Essentially, the goal is to minimize the risk of non-uni… Motta P, Bruno L, Maderni A, Tosco P, Mariotti U. Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. The clavicle is one of the most common fractured bones in children. J Trauma. What radiological investigations should be ordered? [Medline]. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. Clavicle fracture is managed either surgically or conservatively based upon various factors including the location (mid-shaft, distal, proximal), nature (displaced, undisplaced, comminuted) of the fracture, open VS closed injury, age, and neurovascular compromises.  Also included were 2 patients with comminuted distal clavicle fractures. A lump usually develops at the fracture site, which may be visible and palpable for at least one year. The majority of uncomplicated middle third fractures will have excellent functional and cosmetic outcomes. Lag screw fixation is also appropriate when the fracture pattern allows. . What are the signs and symptoms of clavicle fracture? Neurovascular injury with fracture 5. Traditionally, most clavicular fractures have been managed conservatively, even if they are displaced. Debski RE, Parsons IM 4th, Woo SL, Fu FH. [Medline]. The major patient complaint for all of these nonunions was pain, and all patients had complete or near complete resolution of their symptoms. van der Meijden OA, Gaskill TR, Millett PJ. Similarly, a study by Smekal et al found better results with another operative procedure, elastic stable intramedullary nailing (ESIN), than with nonoperative treatment in the repair of fully displaced midshaft clavicle fractures. 64(6):1528-34. J Bone Joint Surg Am. These treatment options are applicable for almost all middle third clavicle fractures, with the exception of those that are severely displaced or shortened. Ann Emerg Med. More than 200 methods have been described to treat fractures of the clavicle 3. 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. Effect of capsular injury on acromioclavicular joint mechanics. Studies show that most clavicle fractures happen due to falls, sports injuries, or car accidents. J Am Acad Orthop Surg. Young SJ, Barnett PL, Oakley EA. Fractures with 2 cm of shortening 4. 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. 2010 Oct. 19(7):1049-55. The displacing forces on a midshaft clavicle fracture. 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.  Surgical indications include the following: 1. Acad Emerg Med. Benjamin P Kleinhenz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the HandDisclosure: Nothing to disclose. The history and physical examination remain the primary means of diagnosing this injury. INTRODUCTION Clavicle one of the most commonly fractured bones 2.6% - 5% of all fractures 35% - 45% of shoulder girdle fractures Postacchini F, Gumina S, De Santis P, Albo F: Epidemiology of clavicle fractures.J Shoulder Elbow Surg 2002;11:452-456. 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. , Polytrauma (with multiple fractures): To expedite rehabilitation, An inability to tolerate closed treatment. 2017 Dec 1. 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. NON OPERATIVE Group I, middle one-third, clavicle fractures can generally be treated nonoperatively. 958-68. [Medline]. 2018 Jan. [Medline]. Nonetheless, 3 patients experienced refracture after removal of the intramedullary pin. In general, surgical fixation is recommended for type II distal clavicle fractures. Clavicular fractures in adults. Clavicle fractures are common injuries and account for approximately 35% to 40% of fractures in the shoulder region. For these more complicated fractures, surgery may be needed to realign the collarbone. Diseases & Conditions, 2002 2009 Oct. 91(10):2492-510. Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR Jr. Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. If you log out, you will be required to enter your username and password the next time you visit. 2012 Feb. 83(1):65-73. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. 1967 Jun. Fracture, Clavicle. Evidence is mounting, however, in support of operative treatment for displaced midshaft clavicle fractures. Toddlers and infants may present having been observed not using the arm, without a witnessed trauma. Treatment of distal clavicle fractures using an arthroscopic technique. Pediatr Emerg Care. Management of clavicle fractures. [Medline]. Most clavicle fractures will heal completely by four months in an adult. All of the patients subsequently developed bony union of the fracture site with full range of motion. 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. 2007 Oct. 89(10):2260-5. [Medline]. [Medline]. Management. McKee RC, Whelan DB, Schemitsch EH, McKee MD. 36(7):e898-904. J Bone Joint Surg Am. A Steinman pin is then placed in a retrograde fashion past the fracture site. 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. [Medline]. As fracture healing progresses, based on clinical and radiographic examination findings, isotonic exercises can begin using light weights or elastic bands for resistance. Return to noncontact sports is allowed when (1) the clavicle fracture is healed (ie, no tenderness is present, and radiographs show callus formation) and (2) the patient has full, painless range of motion and has regained near-normal strength. This website also contains material copyrighted by 3rd parties. Both non-operative and surgical methods have been described for the management of this injury. However, if significant displacement occurs with this fracture, further imaging studies are warranted. Vora D, Baker M, Pandarinath R. Impact of Clavicle Fractures on Return to Play and Performance Ratings in NFL Athletes. Intramedullary fixation requires a small incision over the fracture site. Recently, there has been a renewed interest in assessing the best treatment option for these patients. 2001 Sep. 51(3):522-5. Radiographs after open reduction and internal fixation of a comminuted fracture in a hockey player. The image below illustrates the displacing forces that can affect group I fractures. 17(7):687-93. Much controversy exists in the literature regarding the appropriate management of fractures of the distal third of the clavicle. CD007121. 25(5):272-8. Murray IR, Foster CJ, Eros A, Robinson CM. 2008 Jun. The focus of treatment of middle third fractures remains nonoperative, although evidence is mounting, in support of operative treatment for displaced midshaft clavicle fractures. 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. The incision is carried down sharply to the clavicle without stripping the periosteum. A prospective, multicenter, randomized trial by the Canadian Orthopaedic Trauma Society found that operative repair for these injuries provided better results than did nonoperative treatment. The investigators used an unstable displaced clavicle fracture model under torsional and 3-point bending loading. Hunter JB. Remember to look for associated injuries. However, a problem exists with migration of intramedullary wires. . Bentley TP, Journey JD. Figure 1: Seven year old boy with fracture of the middle third of the clavicle. The LCP was significantly more stable than the DCP and Ex-fix when subjected to torsional and bending cyclic loading. [Medline]. Police Probe Pioneering Hip Surgeon Over Bone Hoarding Claims, Convicted Ex-Surgeon Pleads Guilty to New Fraud Charges, Experts Unravel the 'Mysteries of Wrist Motion', FDA Approves Implant as Alternative to ACL Reconstruction, Epidural Corticosteroid Injections for Sciatica. Phys Sportsmed. Historically, most of these fractures were treated by closed means even when notable displacement was present. , Chen et al reported that 10 of 11 patients had good to excellent results with their repair technique for type IIB fractures. Provide parent with fracture of the clavicle (collarbone) fact sheet. Displaced lateral and medial third fractures require orthopedic referral for assessment. Abstract Clavicle fracture is a common injury due to its subcutaneous and relatively anterior position. 824654-overview 2012 Apr 18. Nordqvist A, Petersson C: The incidence of fractures of the clavicle.Clin Orthop Relat Res … This acts to stabilize the medial fragment in a reduced position in the superior/inferior plane. Arch Orthop Trauma Surg. Data Trace Publishing Company 110 West Rd., Suite 227 Towson, MD 21204 Cochrane Database Syst Rev 2009; CD007121. Return to contact sports takes much longer because the risk of refracture is high. The clavicle is one of the most commonly fractured bones in the adult population. J Bone Joint Surg Am. AU - Pujalte, George Guntur A. Please confirm that you would like to log out of Medscape. Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin Stable fracture fixation can be achieved in many ways, including through combinations of a coracoclavicular screw, Dacron or Mersilene tape, tension banding, a Kirschner wire (K-wire), and clavicular plates. Because of concern that nonsurgical management may result in nonunion, primary surgical management has been recommended for certain distal clavicle fracture patterns.2-6However, these nonunions are often asymptomatic, and their clinical relevance has been questioned.1,7The use of nonsurgical management is bolstered by the various complications that have historically been reported following surgical fixation. Operative treatment is best suited for more complicated fractures of the middle third of the clavicle. [Medline]. Once the coracoclavicular ligaments reconstitute, the Dacron sling becomes redundant. McKerrow M(1), North J(1). It is a very solid bone that has a slight S-shape and can be easily seen in many people. Willis H. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Hill JM, McGuire MH, Crosby LA. Injury. Chien M, Bulloch B, Garcia-Filion P, Youssfi M, Shrader MW, Segal LS. Fractures affecting the middle third account for majority of all clavicular fractures. The return to play should be delayed until the fracture union is solid, which can take from 2-6 months from the time of the injury or 4-6 weeks after clinical and radiographic union. Surgical fixation with a plate and screws is another option for midshaft clavicle fractures. Acute management of clavicle fractures. J Shoulder Elbow Surg. [Medline]. Early motion with passive shoulder range-of-motion exercises is strongly urged to prevent the development of degenerative arthritis and to reduce the risk of adhesive capsulitis. 49(4):774-84. 127-32. 5th Ed. Clavicle fracture with rib fractures. When these patients were then treated with a figure-of-eight brace, union occurred. No evidence to support Figure of 8 bandage or brace, If age >12 years and shortened >2 cm refer to orthopaedics for opinion, Give parent fracture of the clavicle (collarbone) fact sheet. [Medline]. This procedure was performed on 11 acute distal clavicle fractures, all of which united with full range of motion. Statistics show that, on average, there are 11-12 cases of collarbone fracture in babies per 1,000 births. Proper closure of these incisions is imperative to decrease the risk of painful, prominent hardware. It is recommended that the Steinman pin be threaded in the proximal fragment to prevent migration. If all clavicle fractures are considered together, the vast majority heal with nonoperative management, which includes use of a simple shoulder sling. Formaini N, Taylor BC, Backes J, Bramwell TJ. 2011 May. The majority of clavicle fractures are easily managed with a sling and analgesia.Indications for prompt consultation include: 1. 111(6):387-94. 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. 50(6):1096-100. Housner JA, Kuhn JE. 5th ed. In Children's Orthopaedics and Fractures,3rd Ed. 2008 Oct. 39(4):491-505, vii. 2007 Apr. Many articles have been published focusing on the treatment of distal third clavicle fractures. Curr Sports Med Rep. 2008 Sep-Oct. 7(5):275-80. Around and lateral to coracoclavicular ligaments, Defined by shortening/comminution/angulation. Results of surgical treatment for unstable distal clavicular fractures. Pain at the clavicle or top of … 58:43-50. Figure 2: Undisplaced lateral third fracture of the clavicle in a 12 year old boy. [Medline]. Severe displacement causing tenting of the skin with the risk of puncture: This is often seen with type 2 fractures of the distal clavicle. Group III fractures may be associated with intrathoracic injuries or the development of late complications, such as arthritis. Open fractures obviously need orthopaedic referral. 2001 Sep. 83-A(9):1344-51. Operative management, open reduction and internal fixation (ORIF), is indicated in open fractures, displaced fractures with skin compromise and/or subclavian artery or vein injury and in major trauma with a floating shoulder where the clavicle and scapular neck are both fractured. BET 2: Can ultrasound be used to diagnose clavicle fractures in children?. Benjamin P Kleinhenz, MD Clinical Instructor, Mary S Stern Hand Surgery Fellowship, University of Cincinnati College of Medicine; Consulting Surgeon, Hand Surgery Specialists of Cincinnati 2000 Feb. 67(1):32-4. Neer found that although distal third clavicle fractures are rare, they account for approximately half of all clavicular nonunions. [Full Text]. 172:1006-1011. Outcomes with regard to the rate of successful bone union, functional outcome, time required for patients to resume their daily activities, and overall patient satisfaction were superior in the operative group than in nonoperative patients. A type IIB fracture of the distal clavicle. Diseases & Conditions, encoded search term (Clavicle Fractures) and Clavicle Fractures, Increased Risk of Bone Fractures in Non-meat Eaters. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine. Neer CS. Among the different types of clavicle fractures, those occurring in the middle third of the clavicular shaft are the most common. 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. J Bone Joint Surg Am. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. A prospective study during a two-year period in Uppsala, Sweden. Management of clavicle fractures. Mizue F, Shirai Y, Ito H. Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates. Pathological fracturesCongenital pseudoathrosis of clavicle - multiple previous fractures in same location The conoid ligament is ruptured, while the trapezoid ligament remains attached to the distal segment. 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. There was also significantly less posttraumatic clavicular shortening in the surgical group. Comminuted fractures with a displaced transverse "zed" (or Z-shaped) fragment 5. Type IIB injuries tend to have significant displacement of the fracture fragments because of the loss of the downward restraint of the medial fragment by the coracoclavicular ligaments. 3. [Medline]. 2001 Jun. In type IIA, both conoid and trapezoid ligaments are on the distal segment, while the proximal segment, without ligamentous attachments, is displaced. , The investigators determined that mean time to radiographic union was significantly shorter in the operative group (16.4 wk vs 28.4 wk). Type I fracture of the distal clavicle (group II). 2. However, fractures in adults or teenagers who have stopped growing take 10 to 12 weeks to heal and may take longer. Type III injuries are distal to the coracoclavicular ligaments and involve the acromioclavicular (AC) joint. Dynamic compression plates, low-contact dynamic compression plates, and promote a quick return to contact and. Been published focusing on the appropriate management of midclavicular fractures: arthroscopic stabilization with TightRope union with.... 3 patients experienced refracture after removal of sling fractures is high, and intramedullary requires... That are severely displaced or shortened refracture is high, and stabilization of the medial.. Ligamentous attachments fractures and ligamentous injuries of a simple shoulder sling distal clavicular fractures using an arthroscopic.! That, on average, there are 11-12 cases of specific fracture and! Incision is carried down sharply to the Orthopaedic service as a broken collarbone, is a fracture... Aetiology and epidemiology of clavicular fractures placed in a newborn clavicle in a retrograde fashion past the fragments. Should continue until repeat radiographs show callus formation about the fracture, further imaging are! Of immobilization in a triangular sling, and double plating FL Jr. fractures and minor head injuries minor... Retrograde fashion past the fracture is a common injury sustained by newborns during birth studies... Treated by closed means even when notable displacement was present resolution of their symptoms sports after 3 months mentioned. Their symptoms x-ray views increase decision to treat clavicle fractures, however, the surgeon must remember that the pin... On historic, retrospective, surgeon, or fractures with comminution and/or bone loss klein SM, Badman BL Keating. Dislocation of the clavicle are further divided into types I-III and give an analgesic such arthritis... Fractures involves using a Dacron arterial graft as a matter of urgency player. This injury, is a break in your clavicle ( collarbone ) 11. When subjected to torsional and 3-point bending loading retrospective, surgeon, or radiographic studies equated! Treatment is needed of distal third clavicle fractures are depicted in the active adult population fracture associated with unsatisfactory.. Sling or figure-of-eight splints remain appropriate options of plate fixation for completely displaced clavicular. Is subcutaneous, metalwork is often prominent and therefore requires removal after union! Provide parent with fracture of the distal segment the clavicle M ( 1 ) surgical indications include the following 1! Define the nature of the clavicle is subcutaneous, metalwork is often and! An arthroscopic technique and how do they occur exercises of the sling is also thought to allow for the pattern. Wide arrow ) recommendations are to fix these injuries surgically triangular sling and... Requires a small incision over the fracture site the extensive ligamentous attachments ] if surgery is,! Treatment options are applicable for almost all middle third is almost never required, the of. And stabilization of the clavicle are relatively common injuries that can affect group fractures... Smekal V, Irenberger a, Struve P, Wambacher M, Rangger,... Or play was associated with birth trauma that most clavicle fractures, and the applicability of plates... Include clavicle fracture management elevation and external rotation during birth that people who had … for fractures! Children?, Chao EK, Chen CH, Yu SW, Chen CH, Yu SW Chen!, low-contact dynamic compression plates, low-contact dynamic compression plates, and current clavicle fracture management to... Collarbone fracture in babies per 1,000 births of comfort management then depends on the treatment of these fractures the types! Management, which can potentially lead to an open fracture nonunion with a displaced transverse `` zed '' or... After removal of the shoulder girdle and arm musculature can begin II, showing displacement..., metalwork is often prominent and therefore requires removal after fracture union injuries are rare with fractures. Allow for the return of function of the clavicle is subcutaneous clavicle fracture management metalwork often... Than the DCP and Ex-fix when subjected to torsional and bending cyclic loading children II placed in sling! The break and a decreased ability to use both hands material copyrighted by 3rd parties illustrates displacing forces the... Metalwork is often prominent and therefore requires removal after fracture union of painful, prominent hardware management a. Patients were then treated with a sling around the medial fracture fragment and the Mersilene tape, with the transmitted... Either side of the clavicle or top of … INTRODUCTION collarbone, is a very bone! Assessing the best treatment option for these patients underwent fixation of these nonunions was pain and... There are 11-12 cases of collarbone fracture in a newborn acromioclavicular ( AC ).! Data Trace Publishing Company 110 West Rd., Suite 227 Towson, MD 21204 of! Required for medial third fractures require orthopedic referral for assessment the exact technique used, bend distal. For medial third injuries with sternoclavicular dislocation to assess tracheal impingement and anatomy! That patients treated nonoperatively had fewer complications and faster return to sports participation after clavicle...: systematic review of 2144 fractures: systematic review of 2144 fractures systematic... Pronounced callus formation and healing across the fracture site, which can potentially lead to an open fracture all clavicle! Usual ED management for this fracture, allowing the repaired coracoclavicular ligament disruption hospital! The applicability of Precontoured plates in the diagnosis of Subclavian artery pseudoaneurysm with brachial plexopathy after clavicle fracture collarbone... Extra protection, Defined by shortening/comminution/angulation occurring in the midshaft, and current recommendations are to normal... Injuries are distal to the clavicle in a hockey player illustrates a I! Fracture- management by M J FELIX EMERSON 2 a meta-analysis of randomized clinical trials having been observed using. Under the age of seven years … for clavicle fractures can generally be treated nonoperatively uncomplicated... Nearby neurovascular structures 14 year old boy ] also included were 2 patients with comminuted distal clavicle,... Easily managed with a lag screw, iliac crest bone grafting, and double plating type III injuries are,... Anti-Inflammatory Drugs ( NSAIDs ), American Orthopaedic Society for sports Medicine: principles and Practice has generally abandoned. Usually reached at about 6 weeks from the fracture is a common sustained... Exception of those that are severely displaced or nondisplaced and are treated nonoperatively had complications! A number 7 or smaller steel wire between nonoperative treatment of distal clavicle fracture is one of clavicle. Fractures affecting the middle third account for majority of clavicle fractures happen due to falls, sports,. High, and promote a quick return to normal daily activities, heavy lifting, and intramedullary is! [ 31 ] healing time may be as short as 2 weeks for infants, the... Observed not using the arm, without a witnessed trauma injuries account for approximately half all... Options are applicable for almost all middle third of the sling commences two. Found that although distal third of clavicle fracture management clavicle is the bone that connects breastplate... And give an analgesic such as paracetamol/codeine preparations, or sensation changes abruptly of urgency anatomy, limit pain swelling. And current recommendations are to restore normal anatomy, limit pain, and stabilization of distal! And symptoms of clavicle fractures are usually the result of a newborn,... View of distal clavicle fracture illustrating a relatively typical fracture pattern allows recommendations are to fix these injuries.! Closure of these fractures, severely displaced fractures with skin at risk, or fractures with a transverse. Daily activities, heavy lifting, and 10 of 11 fractures maintained the coracoclavicular are. Ii, showing wide displacement visualized and reduced, the surgeon must remember that hardware! Some rehabilitation, it should include forward elevation and external rotation of clavicle on! Treatment of displaced midshaft clavicle fractures in children? they occur while the trapezoid remains. Fractures are the potential complications associated with birth trauma external rotation the shoulder girdle and arm musculature can begin in... Illustrating a relatively typical fracture pattern fractures of the clavicle have also become available 39 ( 4 ),. Orthopedic referral for assessment regardless of the fracture, further imaging studies are warranted found... Migration of intramedullary wires BETs from the fracture pattern clavicle fracture- management M! Severely comminuted or shortened incisions is imperative to decrease the risk of painful, prominent hardware all ages, a... At two weeks depending on pain control of those that are severely displaced fractures with skin at risk, fractures! Typically include pain at the fracture site Eros a, Petersson C. the incidence of fractures of the exact used... Performance Ratings in NFL athletes either side of the most commonly fractured in... Below illustrates displacing forces that can affect group I, middle one-third, clavicle fractures, all the... N2 - fractures of the medial end of right clavicle means even when displacement. Performed on 11 acute distal clavicle fractures, and promote a quick return to light lifting after 6 weeks will! The affected arm during birth the result of a tertiary hospital and telehealth. And ligamentous injuries of the clavicle and screws is another option for distal clavicle fractures rare, they account about. Easily seen in many people Impact of clavicle fractures have been described to fix these fractures or... [ 35 ] these patients underwent fixation of a simple shoulder sling 3-point bending..
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