Jan 18, 2012 displacement of the medial clavicle is seen when the cc ligaments are disrupted edinburgh type 3b. For the most part, they have been historically treated conservatively with acceptable results. They most commonly are extraarticular fractures with minimal or no. Surgical treatment of a medial clavicle fracture nonunion. Apr 12, 2020 clavicle fractures can be treated either. Pdf displaced medial end clavicular fractures treated with an. The natural history and optimal management of these rare injuries are unknown. Whilst they may be very painful, clavicle injuries are rarely serious and in most cases are managed. Medial clavicle fracture dislocation surgically treated clinmed. Fractures of the medial third account for 5% of cases and are usually caused by direct chest trauma.
Displaced middle third clavicle fracture fractures requiring orthopaedic referral. Fractures of the distal third or acromial end of the clavicle are classified as group ii, and fractures of the medial third or sternal end are classified as group iii. Department of thoracic surgery and department of trauma and orthopedics, guys hospital, london, united kingdom. Displacement of the medial clavicle is seen when the cc ligaments are disrupted edinburgh type 3b. The anatomically precontoured fixation system with angular stability for clavicle shaft and lateral clavicle. Cole section 6 shoulder 152 clinical points most clavicle fractures affect the middle third of the bone. Basics anatomy first to ossify last to close 2125 yo 80% of growth is medial rotates 50 along its long axis elevates 30 mechanism 90% direct blow ends most medial injuries are physeal fractures until proven otherwise lateral physeal fractures are often mistaken for ac joint injuries. Medial fractures are less likely to be displaced compared to those of the diaphysis, seldom involve the sternoclavicular joint, and most often are treated nonoperatively. Medial and lateral distal clavicle fractures how to manage the ends. Anatomic reduction fracture reduction and fixation to. Most people will argue against us for the superficial cervical block and i agree its not necessary. A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. Symptomatic nonunion arises up to 8% of medial clavicle fractures when treated conservatively. Sep, 2017 fractures of the medial clavicle are rare comprising 24% of all clavicle fractures while those of the distal clavicle account for approximately 1030%.
Ct angiogram can assist with delineating injury to the vascular structures. This type of fracture is fairly commonaccounting for about 5 percent of all adult fractures. Fractures of the medial third of the clavicle edinburgh type i are nearly always treated nonoperatively. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it snaps or breaks. Although rare, such injuries deserve rapid diagnosis and effective treatment to avoid future complications. Sternoclavicular joint reconstruction in the setting of. Superficial cervical plexus block is a simple block to do and you can basically do a high interscalene then move and deposit local under the scm and cover majority of the clavicle. Mathes the collarbone or clavicle is a bone that connects the shoulder blade to the chest bone. A clavicle fracture, aka broken collar bone, is a common injury usually caused a fall, direct blow or car accident. The patient is brought to the operating room and then placed under light anesthesia. Clavicle fractures non operative treatment sling for comfort initially. A ct scan can better delineate the injury, the direction of displacement anterior versus posterior, and possible injuries to mediastinal contents.
Undisplaced fractures of both the diaphysis and the lateral end of the clavicle have a high rate of union, and the functional outcomes are good after nonoperative treatment. These clavicle fractures are uncommon, are frequently nondisplaced or minimally displaced, and rarely involve the sternoclavicular joint. The operative outcomes of displaced medialend clavicle fractures. Clavicle fracture broken collarbone orthoinfo aaos. Medial clavicle fractures have classically been described as uncommon, comprising less than 5% of all clavicle fractures.
An isolated traumatic medial third clavicular fracture requiring. Acute medial clavicle fracture in adults journal of orthopaedics. The coracoclavicular ligament is a vertical stabilizing structure for the acromioclavicular joint and plays an integral part in clavicle fracture classification. Nonsurgically, which is the preferred method when the fractured clavicle is still lined up correctly. Medial end clavicular fractures are a rare occurrence. The acumed anterior clavicle plate is designed for surgeons who prefer an anterior approach to treat malunions, nonunions, and fractures of the medial, midshaft, and lateral third clavicle. Fractures of the medial clavicle are rare injuries but are associated with signi. The purpose of this study was to examine the complication pro. Type ii fractures involving the lateral third of the clavicle and constituting around 20% of all clavicular fractures when displaced, these type are often unstable. An anteriorly or outwardly protruding medial clavicle suggests an anterior sternoclavicular dislocation but may be caused by a medial fracture sometimes called a pseudodislocation of the sternoclavicular joint. A medial clavicle fracture was defined as one that occurred in the anatomic medial third of the. Group iii fractures, referred to as medial fractures, are less common and make up about 2 to 4% of all clavicle fractures. A fractured clavicle, or fractured collarbone, is a common sports injury that generally occurs from an impact to the shoulder of a fall on an outstretched arm. Other important complications to assess for include neurovascular injury and any puncture injury haemothorax or pneumothorax.
Medial clavicle fractures are difficult to appreciate with plain radiographs. Natural history of medial clavicle fractures injury. Ankle fractures medial malleolar fractures non operative treatment make sure you have a full length fibula xray below knee plaster and crutches re xray at 12 weeks to ensure no displacement plaster off at 6 weeks xray out of plaster at 6 weeks clinical union no pain avhap educational talk 28 june 2011, duy thai. Jan 01, 2008 clavicle fractures constitute 5 to 10 percent of all fractures. Clavicle fractures occur at 3064 cases per 100,000 a year and are responsible for 2. Healing time for most clavicular fractures in adults is 46 weeks. Open subtypes 2 your digital gateway to expertise, education, and innovation. Fractures of the medial end of the clavicle sciencedirect. This only occurs with approximately five percent of all clavicle fractures.
Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 april 2015 v1s. Broad arm sling to support limb for 2 weeks or until comfortable. If you continue browsing the site, you agree to the use of cookies on this website. Type iii remaining 5% occur in the medial third of the clavicle, commonly associated with multisystem polytrauma as the mediastinum sits directly behind the medial aspect of the clavicle, they can be associated with neurovascular compromise, pneumothorax, or haemothorax. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. The distal clavicle fracture, the middle clavicle fracture, and the medial end clavicle fracture. Operative treatment of these fracture is usually considered for open injuries, and fractures with neurovascular compromise or overlying skin compromise 5, 6. Pdf hook plate for medial clavicle fracture arndt schulz. Fractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures.
The lateral fragment is usually displaced inferiorly by the weight of the upper extremity 1 and medially by the pull of the latissimus dorsi and pectoralis muscles 2 and the unopposed rotation of the scapula 3. Medial and lateral distal clavicle fractures how to. We present an isolated medial clavicular fracture associated with significant displacement and demonstrate excellent results after open reduction and internal fixation. Fractures of the medial clavicle are rare comprising 24% of all clavicle fractures while those of the distal clavicle account for approximately 1030%. As such, little is known regarding the epidemiology or treatment of medial clavicle fractures. Pdf medial end clavicular fractures are a rare occurrence. Medial clavicle is innervated by the cervical plexus. Anatomic reduction fracture reduction and fixation to restore anatomical relationships. It is established that this fracture configuration leads to nonunion rates as high as 28% 4. Medial and lateral third clavicle fractures should be discussed with the orthopaedic team and managed on their advice. Although not every fracturedislocation of the medial clavicle needs a. Lcp superior clavicle plate with lateral extension lcp superior clavicle plate.
While most of these fractures can be appropriately managed with a nonoperative treatment, some cases of symptomatic nonunion might be surgically addressed to preserve sternoclavicular joint stability and ensure favorable outcomes. The current trend is shifting from conservative treatment to surgical intervention to reduce longterm sequelae. While most of these fractures can be appropriately managed with a nonoperative treatment. Non operative management of common fractures author. No evidence to support figure of 8 bandage or brace. Fractures of the clavicle are a common injury and most often occur in younger individuals. The most commonly encountered fractures, those of the middle third or midshaft of the clavicle, are classified as group i. Nonoperative treatment of displaced shaft fractures may be associated with a higher rate of nonunion and functional deficits than previously reported.
Fractures affecting the medial third of the bone may be associated with more serious thoracic injuries. Pdf displaced medial end clavicle fractures treated with and inverted distal clavicle plate contoured through 90 degrees abstract aim. These anatomically contoured plates increase screw purchase in the clavicle and act as a template to aid with anatomic restoration. Patients with clavicle fractures complain of marked pain. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Fractures of the medial clavicle are rare injuries but are associated with significant morbidity and mortality. Clavicle fractures are most common in children and young adults, typically occurring in per sons younger than 25 years. Allman divided clavicle fractures into three types. Medial third clavicle fractures are rare injuries, with limited information available on their characteristics or treatment results. Distal clavicle and medial clavicle fractures springerlink. However, it remains difficult to predict which patients will have these. Give parent fracture of the clavicle collarbone fact sheet.
An isolated traumatic medial third clavicular fracture. Its superficial location, its thin midshaft, and the forces trans. Figure 102 midshaft clavicle fractures typically result in prominence at the fracture site, which corresponds to the lateral end of the medial fragment. Clavicle fracture an overview sciencedirect topics. Medial clavicle fractures are uncommon, and as a result, there is little information available.
The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a level 1 trauma centre. Clavicle fractures account for 5% to 15% of childhood fractures, and are the most common type of fracture in children. Ankle fractures medial malleolar fractures non operative treatment make sure you have a full length fibula xray. Treatment the fracture was addressed utilizing an acumed locking 8hole distal plate j. With a simple arm sling to keep the clavicle pieces in place, the fracture can heal naturally without the need for invasive treatments. Pdf surgical treatment of a medial clavicle fracture. Medial clavicle fractures most commonly occur in middleaged men. When the medial clavicle is displaced posteriorly or inwardly, it is often difficult to palpate. Among these, medial end clavicle fractures are rare and make up only 210% 3 6 of all clavicle fractures.
Broken collarbones are most common in children in young adults. Surgical technique first, antibiotics are administered in the holding room prior to surgery video 1. Jun 28, 2019 medial clavicle fractures are uncommon injuries, accounting for 23% of all clavicle fractures 1, 2. Urgent orthopaedic referral is required for displaced medial or lateral third fractures, open fractures, compromise of overlying skin or. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a level 1.
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