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
clavicle fracture

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

source