Mid-Shaft

Clavicular Fractures
Jose Mari R. De Vera
Pre-resident
Report Outline
Epidemiology
Mechanism of Injury
Anatomy
Clinical Evaluation
Diagnostics
Classification
Treatment
Complications
Summary
 Epidemiology
2.6% of all fractures
1.64% of all internal injuries
44% of fx of the shoulder girdle
Men (68%) > women (32%)
Left side (61%) > right side
Middle 1/3rd most common (81%),
Displaced in 48%, Comminuted in 19% (39%)
Traffic accidents in Adults

(Postacchini F, JSES 2002;11:452); ONEISS DOH 2014

Mechanism of Injury
Anatomy
Anatomy
Anatomy
Clinical Evaluation
Clinical Evaluation
ROOS/EAST
Akimbo test
Clinical Evaluation
P-leuritic pain
T-racheal Deviation
H-yper Resonance
O-nset sudden
R-educed breath sounds (and/or dyspnea)
A-bsent fremitus
X-ray shows collapse
Diagnostics
Serendipity view
Diagnostics Zanca View
Classification

Allman
Classification
Classification
Classification
Absolute indications
Open fracture
Neurovascular Injuries
Relative Indications
Displaced fx with impending skin compromise
Shortening >20mm
Significant comminution (>3 fragments)
Fracture shortening >1.5 to 2 cm, or 14% to 15% of the contralateral side,
polytrauma, floating shoulder, significant seizure or neuromuscular disorder,
Treatment
Non-operative: the majority of clavicular fractures can be treated conservatively with
good outcomes
Allman Group I: Non-displaced
Technique:
Arm sling, Clavicular Strap, Figure-of-Eight
Gentle ROM exercises at 2-4 weeks
Treatment
Treatment
Operative:
Allman Group I: Displaced
Open Fracture
Symptomatic Nonunion
Great Vessels injuries with or without Brachial Plexus Injury
Floating Shoulder (Clavicle and neck of scapula fracture)
Bilateral Fracture/Multiple Fractures
Wide displaced Fracture (>=2cm)
Treatment
Operative:
External Fixation
Intramedullary Fixation
Plate Fixation
Treatment
Treatment
Treatment
Complications
Complications
Complications
Summary
Majority of clavicle fractures heal with non-operative care
Aside from absolute indications, fractures with Shortening, Comminution and an
Increaing number of fragments benefit from operative intervention
Operative treatment has a nonunion rate of 2.2%
Nonoperative treatment non union rate ranges from 20 - 25%
Antero-inferior plate-placement is advantageous over Superior plate positioning
IM fixation has many advantages in the hands of a skilled surgeon