Common Adult Fractures

Dr. Sayid omar Mohamed

 Fractures of the Clavicle

Anatomy of the Clavicle

MOI
Classification

Radiographic evaluation
Treatment (operative vs nonoperative)
 Anatomy of the Clavicle

S”shaped bone
Joints
Medial - sternoclavicular joint
Lateral - acromioclavicular joint and coracoclavicular
ligaments
Muscle attachments:
Medial: sternocleidomastoid
Lateral: Trapezius, pectoralis major
Acromio-claviclar joint Sternoclavicular joint

Coraco-clavicular ligaments
 Distal Clavicle
Coraco-clavicular ligaments

Two components:
Trapezoid
Conoid
Stronger than AC ligaments
Provides vertical stability to AC joint
 Mechanism of Injury

MCC: fall on an outstretched hand

Direct blow to the anterior or superior clavicle (rare)
 Other common MOI:
 Fall from height
 Motor vehicle accident
 Sports injury
 Blow to the point of the shoulder
 Physical Examination
Inspection
Evaluate deformity, swelling, echymosis &
displacement
Compare to opposite side
Palpation
Evaluate tenderness
Look for instability with stress
Evaluate Shoulder ROM
Neurovascular examination
Evaluate upper extremity motor and sensation
Proximal end pulled upward by
Sternocleidomastoid Muscle

Distal end pulled downward

By weight of limb
 Proximal end pulled upward by
Sternocleidomastoid Muscle

Distal end pulled downward

By weight of limb
 Radiographic Evaluation

30-degree Cephalic Tilt View

Anteroposterior View
 Classification of Clavicle fractures
According to the site of fracture

Group I : Middle third

Most common (80% of clavicle fractures)

Group II: Distal third

10-15% of clavicle injuries

Group III: Medial third

Least common (approx. 5%)
 Treatment of Clavicle fractures

Non-operative (Standard of care for most

clavicle fractures)
Sling or brace
Surgical
Plate fixation
Screw or pin fixation
Titanium elastic nailing
 Indications for ORIF

Open fractures
Fractures with neurovascular injury
Completely displaced fractures
Displaced distal third fractures
Floating shoulder
Nonunion
Skin tenting & Cosmetic deformity
 Complications of clavicle fractures

Nonunion

malunion

Neurovascular complications
Post-traumatic arthritis