Fractures of clavicle


 * frequent fractures arising usually indirectly from a fall on the shoulder (sports injuries)
 * most often breaks in the middle third
 * typical dislocation of the medial fragment upwards (pull m. sternocleidomastoideus), lateral downwards (pull by the weight of the limb) and further approximation of both fragments by pull m. pectoralis minor

Classification (according to frequency of disability) - according to Allman

 * Type 1 – middle third fractures
 * Type 2 – lateral third fractures
 * Type 3 – fractures of the medial third

Clinical signs

 * pain limiting movement in the ‎shoulder joint
 * drooping shoulder
 * antalgic holding of HK
 * visible dislocation
 * palpable crepitation and pathological mobility
 * hematoma (in older fractures due to gravity it descends to the breast area)
 * may be an open fracture (often a small perforation of the skin by a fragment)

Complications

 * brachial plexus injury (examine peripheral innervation)
 * vascular injury (a. subclavian – examine pulse on a. radialis, v. subclavian – signs of venostasis)

Diagnostics

 * X-ray in front-back projection, event. an oblique image from the bottom up, which better informs about the extent of the dislocation

Treatment

 * Conservative (predominant)
 * retracting the shoulder dorsally and caudally, continuous pull back with a figure-of-eight bandage or Delbet circles
 * Desault's bandage: extension fixation of the upper extremity of the palm to the stomach area with padding under the arm
 * after fixation control X-ray
 * immobilization for 4 weeks (children 2-3 weeks)
 * healing may be accompanied by a more prominent muscle due to relative restlessness during healing (cosmetic problem - diminishes over time)

Operative (mainly for type 2 fractures – lateral end of the clavicle)
 * percutaneously introduced K-wire (can be supplemented with a loop in the tension cerclage) – long oblique fractures
 * cannulated cancellous screw – transverse or short oblique fractures
 * splint adapted to the shape of the key - reoperation, treatment of jointss

Related Articles

 * Clavicle
 * Upper Extremity Bones