Fractures of clavicle


 * frequent fractures arising usually indirectly from a fall on the shoulder (sports injuries)
 * it most often breaks in the middle third
 * typical dislocation of the medial fragment upwards (pulling of the sternocleidomastoid muscle), and further approximation of both fragments by pulling of pectoralis minor muscle

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

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

Clinical signs

 * pain limiting movement in the shoulder joint
 * drooping shoulder
 * antalgic holding 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)

complication

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

Diagnostics

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

therapy

 * Conservative (predominant)
 * retracting the shoulder dorsally and caudally, permanent pull back with a figure-of-eight bandage or Delbet rings
 * 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 traction cerclage) - long oblique fractures
 * cannulated cancellous screw – transverse or short oblique fractures
 * splint adapted to the shape of the root - reoperation, treatment

related articles

 * Clavicle
 * bones of the upper limb

source

 * PASTOR, Jan. Langenbeck’ s medical web page [online]. [cit. 2010]. .