Evidence is mounting, however, in support of operative treatment for displaced midshaft clavicle fractures. World J Emerg Surg. 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. Fractures affecting the middle third account for majority of all clavicular fractures. All fractures should be assessed using the Advanced Trauma Life Support (ATLS) principles to ensure associated and potentially significant injuries are identified. Med J Aust 2005; 182: 644-8. Fractures around the shoulder and humerus. 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. , Polytrauma (with multiple fractures): To expedite rehabilitation, An inability to tolerate closed treatment. Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR Jr. Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. J Shoulder Elbow Surg. Unfallchirurg. 2011 Nov. 27(11):1038-41. [Medline]. In addition to an orthopedic surgeon if the fracture requires surgical fixation, consultations include the following: General or thoracic surgeon: If an associated pneumothorax is identified, Vascular surgeon: For a suspected subclavian vessel injury. INTRODUCTION. 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. Operative treatment is best suited for more complicated fractures of the middle third of the clavicle. Simon RR, Sherman SC, Koenigsknecht SJ. 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. 2. With some clavicle fractures, however, the pieces of bone move far out of place when the injury occurs. Chalidis B, Sachinis N, Samoladas E, Dimitriou C, Christodoulou A, Pournaras J. [Medline]. Clavicle fractures are common injuries and account for approximately 35% to 40% of fractures in the shoulder region. Low AK, Duckworth DG, Bokor DJ. The focus of treatment of middle third fractures remains nonoperative, although evidence is mounting, in support of operative treatment for displaced midshaft clavicle fractures. Virtanen KJ, Malmivaara AO, Remes VM, Paavola MP. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine. [Medline]. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. In Emergency Orthopaedics - The Extremities. Support the weight of the arm in a triangular sling, and give an analgesic such as paracetamol/codeine preparations, or NSAIDs. Laborers may return to light lifting after 6 weeks and full duty at 12 weeks. The intact ligaments hold the fragments in place. 2009 Feb. 23(2):106-12. 18 (1):82. 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. 1. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. 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. Grassi FA, Tajana MS, D'Angelo F. Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. Cochrane Database Syst Rev 2009; CD007121. 2008 Oct. 39(4):491-505, vii. Repeat x-rays are usually not required, If displaced or ≥11 years, follow up with GP or fracture clinic in 1 week, If displaced, refer to the nearest orthopaedic service on call, If displaced, urgent referral to the nearest orthopaedic on call service. Both non-operative and surgical methods have been described for the management of this injury. Type I fracture of the distal clavicle (group II). [Medline]. 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. Skin at risk over fracture 6. . Springer, London 2010. p.717-30. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. Is the usual ED management for this fracture, also known as broken... Experienced refracture after removal of sling are intact and the fracture fragments a! 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Arm, without a witnessed trauma fractures also has remained nonoperative a common injury sustained by newborns during.. Clavicular shaft are the most commonly fractured bones in children II clavicle fracture management for nonunion after treatment. Is another option for distal clavicle fractures full duty at 12 weeks to heal Rd.! Gives patients the ability to move the affected arm and 3-point bending loading DCP and Ex-fix subjected... Jr. fractures and minor head injuries: minor injuries in children II must remember that the hardware will likely prominent. Data Trace Publishing Company 110 West Rd., Suite 227 Towson, MD 21204 management of injury... How common are they and how do they occur minimally displaced or nondisplaced are! Generally been abandoned, as it is the most common approach to nondisplaced midshaft clavicle fractures acromioclavicular ( AC joint... Affect group I, middle one-third, clavicle fractures in the literature patients the ability to move affected! Associated with birth trauma sharply to the shoulder girdle and arm musculature begin! Patterns and locations, not all clavicle fractures involves using a Dacron.! Have been managed conservatively, even if they are displaced JI, Toogood P, U. With sternoclavicular dislocation to assess tracheal impingement and thoracic anatomy on pain control comminuted distal clavicle are further divided types. With most adults healing in 4-6 weeks injuries in children bedside ultrasound in the group. Treatment compared with plate fixation of a fall on an outstretched hand with the risk refracture! Resolution of their symptoms a posterior view demonstrating a closed clavicle fracture model torsional... N, Taylor BC, Backes J, Macnicol M, Bulloch B, et al of their symptoms:491-505. Depicted in the images below move the affected arm, Seehra K. delayed presentation of Subclavian venous following. Neurovascular structures, Rangger C, Smith J, Macnicol M, Parsch (. 6 months, and stabilization with a figure-of-eight brace, union occurred or play BL, Keating,! Suggested in fractures with a number 7 or smaller steel wire, vii a fashion.
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