DISCUSSION

FRACTURE OF CLAVICLE

DEFINITION
A fracture is a break in the structural continuity of bone, cartilage
and bone ephypyseal.
Clavicle fracture : Loss of continuity of bone that connected
sternum and shoulder.

EPIDEMIOLOGY
Clavicle fractures : 2.6% of all fractures and for 44% to 66% of
fractures about the shoulder.
Middle third fractures account for 80% of all clavicle fractures,
whereas fractures of the lateral and medial third of the clavicle
account for 15% and 5%, respectively.

HANDBOOK OF FRACTURE 2015

ANATOMY

MECHANISM OF FRACTURE

Fractures result from:

(1) Injury
(2) repetitive stress
(3) abnormal weakening of the bone (a pathological fracture).
Apleys

87% : Falls onto the affected shoulder leading to a bending force

account for most of clavicular fracture
7% : Direct impact accounting for only 7%
6% : Falls onto an outstretched hand accounting for 6%.

Rare : clavicle fractures can occur secondary to muscle contractions

during seizures or secondary to minimal trauma due to pathologic
bone or as stress fractures.
Handbook of frx

ASSOCIATED INJURY
Up to 9% of patients with clavicle fractures have additional
fractures, most commonly rib fractures.
Most brachial plexus injuries are associated with proximal third
clavicle fractures (traction injury).
The skin is often abraded as a result of the injury mechanism.

HANDBOOK OF FRX

CLASSIFICATION
Group I: fracture of the middle third (80%). This is the most
common fracture in both children and adults; proximal and distal
segments are secured by ligamentous and muscular attachments.

 Group II: fracture of the distal third (15%). This is subclassified

according to the location of the coracoclavicular ligaments relative
to the fracture:
Type I: Minimal displacement: interligamentous fracture between
the conoid and trapezoid orbetween the coracoclavicular and AC
ligaments; ligaments still intact
Type II: Displaced secondary to a fracture medial to the
coracoclavicular ligaments: higher incidence of nonunion
IIA: Conoid and trapezoid attached to the distal segment
IIB: Conoid torn, trapezoid attached to the distal segment
Type III: Fracture of the articular surface of the AC joint with no
ligamentous injury: may be confused with first-degree AC joint
separation

 Group III: fracture of the proximal third (5%). Minimal

displacement results if the costoclavicular ligaments remain intact.
It may represent epiphyseal injury in children and teenagers.
Subgroups include:
Type I: Minimal displacement
Type II: Displaced
Type III: Intra-articular
Type IV: Epiphyseal separation

DIAGNOSIS
pain,
pain, bruising,swelling,
bruising,swelling,
deformity
deformity
mechanism
mechanism of
of injury
injury
loss
loss of
of function
function

LOOK
LOOK
FEEL
FEEL
MOVE
MOVE
NVD
NVD

MANDATORY!!!
MANDATORY!!! Use
Use rule
rule
of
of two
two ::
VIEWS
JOINTS
LIMBS
INJURIES
OCCASIONS

MANAGEMENT
NON OPERATIVE

OPERATIVE
Plate fixation: This is placed either on the superior or on the
anteroinferior aspect of the clavicle.
Requires a more extensive exposure than intramedullary devices
but has the advantage of more secure fixation counteracting
tensile forces.
Prominent, particularly if placed on the superior aspect of the
clavicle.
Newer low-profile implants and/or anteroinferior placement may
preclude this finding.

 Intramedullary fixation (Hagie pin, Rockwood pin, Sonoma

nail): Usually placed in antegrade fashion through the lateral
fragment and then in retrograde fashion into the medial fragment
or retrograde as a flexible implant that is then stiffened.
Requires frequent radiographic follow-up to monitor the possibility
of hardware migration and a second procedure for hardware
removal.
Older intramedullary pins are prone to skin erosion at the
hardware insertion site laterally.
Historically, these implants have been reported to be associated
with complications in up to 50% of cases.

COMPLICATION
Early

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