Middlethird fractures nonoperative management the goal of clavicle fracture treatment is to achieve bony union while minimizing dysfunction, morbidity, and cosmetic deformity. Patients and methods describing the aetiology and epidemiology of clavicular fractures have been published, and to the best of our during a twoyear period 1 january 1989 to 31 knowledge none of the previously published reports december 1990, all patients. Clavicle fractures constitute 5 to 10 percent of all fractures. Fractures of the clavicle are usu ally thought to be easily managed by symptomatic treatment in a broad arm sling. Studies have found, however, that in cases of specific fracture patterns and locations, not all clavicle fractures behave the same way. Rehabilitation protocol adopted from the massachusetts. No evidence to support figure of 8 bandage or brace. International journal of science and research ijsr is published as a monthly journal with 12 issues per year. 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. However, in some cases, open reduction and internal fixation are required. The infant, child, or adolescent with a clavicle fracture usually has a history of trauma. The degree of displacement and impaction or overriding should be noted.
Treatment of an open infected type iib distal clavicle fracture. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. A clavicle fracture, commonly known as the collarbone, is one of the more painful injuries of the arm and the shoulder. Fractures of the clavicle are extremely common accounting for 5%10% of all fractures. Clavicle fracture is a rather common injury representing approximately 510% of all fracture types and almost half of the entire shoulder girdle injuries 3,10. Type i fracture of the middle third of the clavicle, constituting 75% clavicular fractures as the middle third is the weakest segment.
Clavicle fractures can also be the result of birth trauma. Jan 31, 2011 fractures of the clavicle le kim trong md. Original research article anatomy of the clavicle and its applicability in management of clavicular fractures manjunath cs 1, tejaswi hiremarali lokanathan 2. Distribution and treatment of clavicular fractures in. In a clavicular fracture, the athlete will ususally. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. Fractures were classified by the robinson classification. This has led to the practice of treating all clinically fractured clavicles with a normal radiograph as a. Dec 06, 2011 healing of paediatric clavicle fractures is known to occur within four to six weeks. Clavicle fractures are commonly treated with slings and possibly a figure eight splint. Considering the previous studies together, neonatal clavicular fracture appears to be a transient event without sequelae. The course of treatment typically depends on the type of fracture, because. Clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466% of all shoulder fractures 2. Even displaced fractures have been successfully managed without surgery.
Lateral third clavicle fracture referrals and followup middle third fractures. Surgical treatment for unstable distal clavicle fracture with. Manjunath cs, assistant professor, department of anatomy, hassan institute of medical sciences, sri chamarajendra hospital campus, hassan 573201. If all clavicle fractures are considered together, the vast majority heal with nonoperative management, which includes use of a simple shoulder sling. Deficits following nonoperative treatment of displaced. A clavicle fracture is typically associated with extreme pain, and arm movement is difficult. 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. The emphasis of this article is on the management of these injuries.
Clavicle fracture broken collarbone orthoinfo aaos. A fracture of the clavicle is a relatively common injury that occurs in patients of all ages. Gp follow up in 12 weeks in non or minimially displaced fractures no repeat xray is required orthopaedic fracture clinic follow up in 12 weeks if significant displacement. Shoulder trauma fractures and dislocations orthoinfo. Our radiographic followup in this study was a mean of five weeks, but we do recognise that only 23% of our patients had fracture union confirmed by radiographs. Conservative difficult if spiral or oblique fracture\. Original research article anatomy of the clavicle and its. Rehabilitation protocol adopted from the massachusetts general hospital sports physical therapy program and the american academy of orthopedic surgeons. Any fracture with one or more of the above features should be referred urgently to the nearest orthopaedic surgeon on call for management. Joint replacemen arthroscopysports medicine handfoot surgery dougherty ferry rd, ste. Since these injuries require lengthy periods of time for complete healing and disrupt the patients quality of life, it could be helpful to discuss the injury. Management of type ii distal clavicle fractures has always been a challenge. Notably, it is a referred, highly indexed, online international journal with high impact factor.
Fractures clavicle kids health wa pmh ed guidelines. Jan 01, 2008 clavicle fractures constitute 5 to 10 percent of all fractures. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks. The treatment of clavicle fractures can be divided into conservative no operation or operative. This is an structural anomaly that can cause shoulder impingement. Salterharris 1 and 2 fractures of the medial clavicular physis are most common. They usually require minimal treatment, which relies on analgesia and a collarandcuff.
To compare fracture distribution and treatment in monotrauma and polytrauma patients with a clavicle fracture. A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. Several studies have questioned the clinical relevance of distal clavicle nonunion, however. Healing of paediatric clavicle fractures is known to occur within four to six weeks. If you continue browsing the site, you agree to the use of cookies on this website. Classic teaching suggested that even if both ends of the clavicle were widely separated it would go on to heal.
Surgical management of displaced midshaft clavicle fracture in. Clavicular fractures can be classified by the allman classification system, determined by the anatomical location of the fracture along the clavicle. Kreher, md, boston university, boston, massachusetts c lavicle fractures constitute 5 patient information. Direct mechanism of clavicular fracture may arise from blunt9or penetrating injuries. 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. Nonoperative treatment is preferred for distal clavicle fractures because outcomes are the same whether or not bony union is. Clavicle fractures are common skeletal injuries that are typi cally managed nonoperatively, which results in a high rate of fracture union with few or no. A glenoid neck fracture combined with an ipsilateral clavicle fracture produces a floating shoulder in which there is no stable bony continuity between the upper extremity and the trunk. Acute management of clavicle fractures a long term functional.
A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. The management of clavicle fractures has dramatically changed over the last decade. The timing of surgery for lateralend fractures seems more important for patient outcome when compared with medialthird fractures. A fractured clavicle, or fractured collarbone, is a common sports injury that generally occurs from an impact to the shoulder of a fall on an outstretched arm. The majority of clavicle fractures are treated conservatively. In such situations, the choice of treatment remains a constant dilemma for achieving maximum prefracture functional status. 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.
In pediatric patients, it is more likely a physeal fracture dislocation will occur as the medial clavicular physis appears between 1219 years of age and fuses around 2225 years of age. A fall onto the lateral shoulder most frequently causes a clavicle fracture. Clavicle fractures are relatively common due to their special subcutaneous position. View enhanced pdf access article on wiley online library html view. When analyzing and comparing findings from previous studies, only birthweight was identified as common to the risk factors affecting clavicular fracture. Operative management of clavicular malunion in midshaft.
Surgical treatment of medialend clavicle fractures is indicated if mediastinal structures are placed at risk because of fracture displacement, in. Sternoclavicular fractures and dislocations pediatric. On logistic regression analysis vacuum delivery and birthweight were significant risk factors. Most common approximately 80% in both adults and children. There has been a shift towards surgical management of displaced midshaft clavicle fractures in adults over last decade. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Childhood fracture management education powerpoint presentation 30. This was this study was aimed at identifying the epidemiology and management of clavicular fractures in our environment. Mar 24, 2017 diagnosis and management of distal clavicle osteolysis.
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. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. For the fixation of displaced midshaft clavicular fractures, different plates are available, each with its. Patients with clavicle fractures complain of marked pain, partic. Original research article anatomy of the clavicle and.
The medical literature has focused predominantly on fractures of the middle and distal clavicle but is still lacking concerning the management of medial clavicle fractures. Project overview powerpoint presentation 5 mins for use in the emergency department to promote the new resource at staff meetings. Complications associated with clavicular fracture ceconnection. Studies have examined the different patterns of displacement and clinical outcomes of clavicle fractures according to their location. Jul 15, 2014 fracture classification allman classification. Fractures that need surgery usually have fracture fragments involving the shoulder joint or there is an additional fracture of the clavicle. Although extensive research for the optimal treatment of clavicle fractures has been performed, comparative studies between monotrauma and polytrauma patients are lacking. Place these posters in your clinical areas as a visual reminder of the resources available. This type of fracture is fairly commonaccounting for about 5 percent of all adult fractures. Typically, there is localized pain over the fracture, with associated edema and crepitus. A displaced midshaft clavicular fracture will heal with a degree of shortening and rotation if managed nonoperatively and radiographic malunion is expected. The clavicle is the most commonly fractured long bone in children.
Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on. The decision whether to operate may be influenced by the amount of fracture displacement and the individual demands of the patient. Historically, only unstable distal clavicle fractures were treated operatively. Surgery involves fixation of the fracture fragments with plates and screws. Clavicle fracture an overview sciencedirect topics. Mechanism of injury is usually a fall on an outstretched hand or a direct blow to the shoulder. For distal clavicle fracture, clavicular hook plate and. Nonoperative treatment has a high risk of complications and should be considered only for elderly and frail patients. In a clavicular fracture, the athlete will ususally hold their arm how. Nonsurgical and surgical management provide similar results.
The goal of management is to provide support for the shoulder. A clavicle fracture is also known as a broken collarbone. Diagnosis and management of distal clavicle osteolysis. 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. Pdf management of type ii distal clavicle fractures has always been a challenge. About 10% to 20% of scapula fractures need surgery. A clavicle fracture should prompt careful reexamination of the ac and the sternoclavicular joints, which may be dislocated or separated by a fracture. Conservative management of clavicle fracture clavicle fractures typically result from a direct blow to the shoulder, occurring most frequently to the middle third of the clavicle. Nonoperative management has long been the preferred treatment for clavicular fractures. Type ii distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion.
Conservative management of paediatric clavicle fractures. This unstable injury requires urgent orthopedic evaluation. These fractures may be partial or complete and often require surgical repair and immobilization while they heal. Middle third most common broad arm sling to support limb for 2 weeks or until comfortable. Midshaft clavicular fractures are the most common 66%. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional. Until recently clavicle fractures were solely the domain of non surgical management. The clavicle bone lies just beneath the skin, so a fracture usually causes an obvious protrusion or bump at the fracture site, along with swelling. Fracture management overview history who, what, when, where, why o who age, job, hobbies, hand dominance if hand involved, cognition amts score if elderly o what happened and exactly how it happened mechanism of injury force involved likelihood of other structure damage o when it happened o where it happened o why. Clavicle fractures are a common orthopedic injury, particularly. Glenoid neck fractures, a juxtaarticular type of scapula fracture, deserve a special mention.
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