The goal of management is to provide support for the shoulder. Distal clavicular fracture as a special form of injury have been. Most clavicular fractures are treated nonoperatively, but severely displaced fractures may be fixed surgically. Deficits following nonoperative treatment of displaced. Treatment of an open infected type iib distal clavicle fracture. A clavicle fracture is also known as a broken collarbone. The degree of displacement and impaction or overriding should be noted. Fractures that need surgery usually have fracture fragments involving the shoulder joint or there is an additional fracture of the clavicle. Diagnosis and management of distal clavicle osteolysis. This type of fracture is fairly commonaccounting for about 5 percent of all adult fractures. The clavicle is the most commonly fractured long bone in children.
Considering the previous studies together, neonatal clavicular fracture appears to be a transient event without sequelae. Surgical options to achieve bony union include transacromial wire fixation, a modified weaverdunn procedure, use of a. While there is extensive research on the types of surgical management of clavicle fractures, as well as studies comparing surgical versus conservative management of clavicle fractures, there is little high level research regarding physical therapy interventions of this diagnosis. Distribution and treatment of clavicular fractures in. Middlethird fractures nonoperative management the goal of clavicle fracture treatment is to achieve bony union while minimizing dysfunction, morbidity, and cosmetic deformity. 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. A clavicle fracture is typically associated with extreme pain, and arm movement is difficult. Mar 24, 2017 diagnosis and management of distal clavicle osteolysis. Pdf management of type ii distal clavicle fractures has always been a challenge. Mechanism of injury is usually a fall on an outstretched hand or a direct blow to the shoulder. About 10% to 20% of scapula fractures need surgery. No evidence to support figure of 8 bandage or brace.
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. Salterharris 1 and 2 fractures of the medial clavicular physis are most common. Any fracture with one or more of the above features should be referred urgently to the nearest orthopaedic surgeon on call for management. 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. Clavicle fractures are commonly treated with slings and possibly a figure eight splint. Clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466% of all shoulder fractures 2. Jul 15, 2014 fracture classification allman classification.
Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. Nonsurgical and surgical management provide similar results. Joint replacemen arthroscopysports medicine handfoot surgery dougherty ferry rd, ste. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. However, in some cases, open reduction and internal fixation are required. Fractures were classified by the robinson classification. Studies have examined the different patterns of displacement and clinical outcomes of clavicle fractures according to their location.
Surgical treatment for unstable distal clavicle fracture with. Complications associated with clavicular fracture ceconnection. Nonoperative treatment is preferred for distal clavicle fractures because outcomes are the same whether or not bony union is. Type i fracture of the middle third of the clavicle, constituting 75% clavicular fractures as the middle third is the weakest segment. Rehabilitation protocol adopted from the massachusetts. 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.
International journal of science and research ijsr is published as a monthly journal with 12 issues per year. The majority of clavicle fractures are treated conservatively. Classic teaching suggested that even if both ends of the clavicle were widely separated it would go on to heal. The course of treatment typically depends on the type of fracture, because. In such situations, the choice of treatment remains a constant dilemma for achieving maximum prefracture functional status. Childhood fracture management education powerpoint presentation 30.
Jan 31, 2011 fractures of the clavicle le kim trong md. Clavicle fractures constitute 5 to 10 percent of all fractures. Typically, there is localized pain over the fracture, with associated edema and crepitus. Original research article anatomy of the clavicle and. Management of type ii distal clavicle fractures has always been a challenge. Until recently clavicle fractures were solely the domain of non surgical management. Surgery involves fixation of the fracture fragments with plates and screws. Clavicle fractures matthew pecci, md, and jeffrey b. The decision whether to operate may be influenced by the amount of fracture displacement and the individual demands of the patient. Middle third most common broad arm sling to support limb for 2 weeks or until comfortable. 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. 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. Glenoid neck fractures, a juxtaarticular type of scapula fracture, deserve a special mention.
This has led to the practice of treating all clinically fractured clavicles with a normal radiograph as a. A clavicle fracture, commonly known as the collarbone, is one of the more painful injuries of the arm and the shoulder. Acute management of clavicle fractures a long term functional. When analyzing and comparing findings from previous studies, only birthweight was identified as common to the risk factors affecting clavicular fracture. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional. Pdf clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466% of all shoulder fractures 2 find, read. Clavicle fractures are a common orthopedic injury, particularly. Although extensive research for the optimal treatment of clavicle fractures has been performed, comparative studies between monotrauma and polytrauma patients are lacking. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on. Major risk factors for clavicular fracture were vacuum delivery and birthweight. Fractures of the clavicle are usu ally thought to be easily managed by symptomatic treatment in a broad arm sling.
Rehabilitation protocol adopted from the massachusetts general hospital sports physical therapy program and the american academy of orthopedic surgeons. Original research article anatomy of the clavicle and its applicability in management of clavicular fractures manjunath cs 1, tejaswi hiremarali lokanathan 2. Operative management of clavicular malunion in midshaft. Studies have found, however, that in cases of specific fracture patterns and locations, not all clavicle fractures behave the same way. Conservative difficult if spiral or oblique fracture\. This unstable injury requires urgent orthopedic evaluation. 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. 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. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. A clavicle fracture should prompt careful reexamination of the ac and the sternoclavicular joints, which may be dislocated or separated by a fracture. Fractures of the clavicle are extremely common accounting for 5%10% of all fractures. Sternoclavicular fractures and dislocations pediatric. 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.
Clavicle fractures can also be the result of birth trauma. Manjunath cs, assistant professor, department of anatomy, hassan institute of medical sciences, sri chamarajendra hospital campus, hassan 573201. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. In a clavicular fracture, the athlete will ususally. If you continue browsing the site, you agree to the use of cookies on this website. The infant, child, or adolescent with a clavicle fracture usually has a history of trauma. Historically, only unstable distal clavicle fractures were treated operatively. They usually require minimal treatment, which relies on analgesia and a collarandcuff.
The emphasis of this article is on the management of these injuries. If all clavicle fractures are considered together, the vast majority heal with nonoperative management, which includes use of a simple shoulder sling. Even displaced fractures have been successfully managed without surgery. 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. 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. 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. These fractures may be partial or complete and often require surgical repair and immobilization while they heal. Original research article anatomy of the clavicle and its.
Clavicular fractures can be classified by the allman classification system, determined by the anatomical location of the fracture along the clavicle. Shoulder trauma fractures and dislocations orthoinfo. In a clavicular fracture, the athlete will ususally hold their arm how. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks. This is an structural anomaly that can cause shoulder impingement. Surgical treatment of medialend clavicle fractures is indicated if mediastinal structures are placed at risk because of fracture displacement, in. Midshaft clavicular fractures are the most common 66%. 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. A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle.
This was this study was aimed at identifying the epidemiology and management of clavicular fractures in our environment. The treatment of clavicle fractures can be divided into conservative no operation or operative. Nonoperative management has long been the preferred treatment for clavicular fractures. Kreher, md, boston university, boston, massachusetts c lavicle fractures constitute 5 patient information. Several studies have questioned the clinical relevance of distal clavicle nonunion, however. 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. For distal clavicle fracture, clavicular hook plate and. Conservative management of paediatric clavicle fractures. Surgical management of displaced midshaft clavicle fracture in. Notably, it is a referred, highly indexed, online international journal with high impact factor.
Place these posters in your clinical areas as a visual reminder of the resources available. Healing of paediatric clavicle fractures is known to occur within four to six weeks. Type ii distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion. 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. The timing of surgery for lateralend fractures seems more important for patient outcome when compared with medialthird fractures. A fall onto the lateral shoulder most frequently causes a clavicle fracture. Clavicle fracture an overview sciencedirect topics. 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. Jan 01, 2008 clavicle fractures constitute 5 to 10 percent of all fractures. A displaced midshaft clavicular fracture will heal with a degree of shortening and rotation if managed nonoperatively and radiographic malunion is expected. Direct mechanism of clavicular fracture may arise from blunt9or penetrating injuries. 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. The management of clavicle fractures has dramatically changed over the last decade. Nonoperative treatment has a high risk of complications and should be considered only for elderly and frail patients.
Lateral third clavicle fracture referrals and followup middle third fractures. Clavicle fractures are relatively common due to their special subcutaneous position. 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. 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. Dec 06, 2011 healing of paediatric clavicle fractures is known to occur within four to six weeks. To compare fracture distribution and treatment in monotrauma and polytrauma patients with a clavicle fracture. Patients with clavicle fractures complain of marked pain, partic. Project overview powerpoint presentation 5 mins for use in the emergency department to promote the new resource at staff meetings. Clavicle fracture broken collarbone orthoinfo aaos.
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