Fractures of the Clavicle (original) (raw)
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Fractures of the clavicle: an overview
The open orthopaedics journal, 2013
Fractures of the clavicle are a common injury and most often occur in younger individuals. For the most part, they have been historically treated conservatively with acceptable results. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional outcomes. This article first describes the classification of clavicle fractures and then reviews the literature over the past decades to form a conclusion regarding the appropriate management. A thorough literature review was performed on assessment of fractures of the clavicle, their classification and the outcomes following conservative treatment. Further literature was gathered regarding the surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted. The majority of recent data suggests that operative treatment may be ...
Management of Distal Clavicle Fractures
Most clavicle fractures heal without difficulty. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Type II distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion. Several studies have questioned the clinical relevance of distal clavicle nonunion, however. Nonsurgical and surgical management provide similar results. The decision whether to operate may be influenced by the amount of fracture displacement and the individual demands of the patient. Surgical options to achieve bony union include transacromial wire fixation, a modified Weaver-Dunn procedure, use of a tension band, screw fixation, plating, and arthroscopy. Each technique has advantages and disadvantages; insufficient evidence exists to demonstrate that any one technique consistently provides the best results.
Journal of Shoulder and Elbow Surgery, 2007
Disability caused by nonunited or malunited fracture of the midshaft clavicle is a rare condition that is expressed by local pain or neurovascular impairment. This condition is usually treated by reduction of the fracture and stable fixation with augmentation by autogenous bone graft. We evaluated the functional outcome in 13 patients who were treated by this method. The mean postsurgical follow-up was 41 months. In all patients, satisfactory osseous union was achieved. Only 46% of the patients returned to their previous professional and recreational activities. There was also evidence that the current Constant scores of the affected shoulders remained significantly lower than those of the normal contralateral side. Ten patients reported various degrees of pain, and only three patients were pain-free. We show that, although solid union after realignment of symptomatic nonunion or malunion of midshaft clavicle fractures is predictable, the patients can remain functionally impaired.
Current concepts in the management of clavicle fractures
Clavicle fractures comprise approximately 3% of all adult fractures and there is evidence that the incidence is increasing. Fractures of the lateral and middle third of the clavicle present distinct challenges in both surgical fixation techniques and clinical outcome, as such they should be recognised as separate clinical entities. Despite conflicting evidence, most studies indicate that superior clinical results are found in patients with united clavicle fractures rather than those that go onto non-union. Furthermore there is level-1 evidence that operative treatment of clavicle fractures leads to significantly increased rates of union. Despite these findings, significant controversy still exists on which patients would benefit from primary fixation and those who could successfully be managed non-operatively. We present an evidence-based review of clavicle fracture management including surgical indications, techniques, and results.
Journal of Shoulder and Elbow Surgery, 2004
The aim of this long-term, prospective study was to identify risk factors associated with the outcome of clavicular fractures. During 1989During through 1991 patients aged 15 years or older with a radiographically verified fracture of the clavicle were included. Clinical and radiographic examinations were standardized. Of the 208 patients seen at the 9-to 10year follow-up, 112 (54%) had recovered completely whereas 96 (46%) still had sequelae. Nonunion occurred in 15 patients (7%). No bony contact was the strongest radiographic predictor for sequelae. Comminuted fractures with transverse fragments had a significantly increased risk for remaining symptoms, as did older patients, whereas there was no significant difference between sexes. Fracture location and shortening did not predict outcome except for cosmetic defects. Angulation of the fracture had no effect on cosmetic defects. Patients with predictive risk factors, such as fractures with no bony contact or displacement, especially if comminuted, and also elderly patients with fractures should be considered for more active treatment options.
Indian Journal of Orthopaedics Surgery
Introduction: For centuries fracture of clavicle has been treated conservatively non-union of clavicle fracture is rare, Mal-union was considered to be of radiographic importance only. The scenario has changed and there has been a shift towards operative treatment on union, cosmesis, early recovery grounds. Both the methods is compared taking into account the union, cosmesis, early recovery, functional outcome and satisfaction of the patient. Materials and Methods: Total 70 patients of displaced fracture of clavicle (AO B1 & B2) were divided into two groups that is non-operative and operative. The informed consent was taken. The patient were explained about both modalities & procedure, cost, outcome and complications of each modality. After the decision of the patient he was allotted to Group I (conservative) & Group II (operative) the study was carried out till 35 patients were included in each group. The follow-up of both group's patients were done at 6 weeks, 3 months, 6 months using patients subjective evaluation, DASH score, range of motion, radiological assessment and complication if any. Observation and Result: Of all 70 patients the age varied between 20-66 years with mean age was 34.5 years. In the conservative group 23(65.7%) and in operative group 26 (74.2%) had dominant side involvement. In non-operative group there were 3(8.75%) cases of non-union, 15 (42.8%) mal-union, 5 (14.2%) muscle wasting, and 4 (11.4%) pressure symptoms in upper limb 2 (5.71%) stiffness of shoulder, 8 (22.85%) pain after union. Of 15 cases of mal-union only 7 (20%). 5 (14.28%) patients complaint of hardware prominence and irritation. Total 4 (11.42%) patients needed implant removal (2 due to infection and 2 due to hardware problem). 6 (17.14%) patients complaint of postoperative infraclavicular hypoesthesia. The DASH score was superior in Group II over I at 6 weeks and at 3 months. Overall in non-operative patients 22 (62.85%) were satisfied (17.14%) were not satisfied in operative group 28(80%) were satisfied while 7 (20%) were unsatisfied. The average follow-up period was 9.5 months (6-18 months). Conclusion: Though operative treatment is better in terms of early mobilization, union, absence of mal-union, cosmetically well accepted, it has its own complication which should also be taken into consideration while choosing between the two modalities. Seeing at satisfaction level in patient related to functional outcome the conservative treatment plays a vital role in poor patients.
Displaced midshaft clavicle fractures in adults – is non-operative management enough?
Injury-international Journal of The Care of The Injured, 2021
Introduction: Displaced fractures of middle third of clavicle are traditionally managed non-operatively. Recently, the trend is towards surgical management considering functional deficits in some of the nonoperatively managed patients. The purpose of the study was to examine the functional outcome of nonoperative treatment in these injuries, while identifying the factors responsible for less than ideal outcome and determine the guidelines for patient counselling. Patients and Methods: One hundred patients with displaced fractures of middle third of clavicle were prospectively evaluated clinico-radiologically for one year from injury. Risk factors for non-union were determined using Fisher's exact test. Logistic regression was used to identify factors contributing to functional outcome. Threshold values for the radiological displacements were estimated with the smooth threshold regression using the logistic transition function. Results: Ninety-four out of 100 fractures united. The factors associated with non-union were: smoking, diabetes and poor soft tissue condition over the fracture. Ninety-two out of 94 patients who had their fractures united achieved "good" (Constant Score above 70) or "very good" (Constant Score above 85) functional outcome at one year, out of which only 49 belonged to "very good" category. The most important factors influencing functional outcome were fracture angulation and clavicular shortening. From the model, it was estimated that with one unit increase in degree of angulation or 1 mm increase in shortening, the odds of scoring above 85 reduces by around 14%. Based on this, an equation and a probability calculator were developed from which the probability of achieving a Constant Score above 85 can be calculated. Threshold analysis yielded 22.8 °for angulation and 16.8 mm for shortening at which the probability of achieving "very good" function is only 0.23. Conclusion: Displaced midshaft clavicular fractures with the intent of achieving "good" outcome must be managed non-operatively. If the patient expectation is not to accept even minor functional deficits, the treatment objective must be raised to achieve a minimum Constant score of 86. Substituting the radiological displacements in the equation, the probability of the patient achieving this objective can be calculated. Non-operative management is offered if this probability figure is acceptable to the patient, otherwise counselled for surgery. Non-operatively managed patients with coexisting diabetes, smoking or poor soft tissue condition must be watched for the possibility of going for non-union.
Zagazig University Medical Journal, 2019
Introduction: Fracture clavicle used to be treated conservatively. But, risk of mal-union and shoulder dysfunction has raised many concerns regarding this way of treatment. Operative treatment for clavicle fracture gained popularity recently for displaced fracture clavicle. So, in our study we compared between the two methods of treatment. Patients and methods: We conducted a prospective study for all adult patient presented to our hospital with unstable fracture clavicle from August 2016 to September 2017. Patients were divided in two groups A and B, with exclusion of poly-trauma patients. Group A treated conservatively and group B treated by open reduction and internal fixation with plate and screws on the superior surface of the clavicle. The patients were followed up and assessed by constant shoulder score. Results: The study included 20 patients in two group 10 patient for each group. The demographic data in both groups showed no significant differences. Follow up was 6.2 and 7.3 months in both groups respectively. Union occurred in 5.8 and 5.3 months in both groups respectively. The difference was insignificant for follow up and union; p value> 0.05. Functional outcome was excellent in 8 and good in 2 in group A, and excellent in 6, good in 4 in group B. This difference was found to be significant, p value ˂ 0.05. Conclusion: From our study and supported by others we recommend that conservative treatment should be the first choice for most patients and operative fixation to be reserved for selected cases.
Comparison of Conservative versus Operative Management in Clavicle Fracture
Indian Journal of Applied Research, 2015
Objective: To compare benefits and implication of conservative versus operative management in Clavicle Fracture. Method: In the present study 30 patients were enrolled and divided into two groups. In one group 15 cases of clavicular fracture were managed conservatively whereas in the other group of 15 cases were treated surgically. Regular follow was done at every four weeks. Patients were looked up for any complication and duration required for union. Results: In present study 30 patients were enrolled. Of them 24 (80%) had middle third clavicle fracture and six (20%) had lateral third clavicle fracture. In conservative group, union was observed between 13 to 16 weeks in 73.33% patients whereas in operative group union was seen in less than 12 weeks in 80% patients. In conservative group malunion was observed in 26.67% patients and delayed union in 33.33% patients. In operative group hypertrophic scar was observed in 20% patients and plate prominence in 13.33% cases. Delayed union was observed in one case due to plate loosening. Conclusion: Operative treatment provided a significantly lower rate of nonunion and symptomatic malunion and earlier functional return.
Clavicular fracture: Complications
International Journal of Orthopaedics Sciences
The clavicle is easily fractured because of its subcutaneous, relatively anterior location and frequent exposure to transmitted forces. The middle third, or midshaft, is the thinnest, least medullous area of the clavicle, and thus the most easily fractured; the lack of muscular and ligamentous support makes it vulnerable to injury. It is often caused by a fall onto a shoulder, outstretched arm, or direct trauma. The fracture can also occur in a baby during childbirth. The anatomic site of the fracture is typically described using the Allman classification, Group I (midshaft) fractures occur on the middle third of the clavicle, group II fractures on the lateral (distal) third, and group III fractures on the medial (proximal) third.