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
Typ 1 – middle third fractures
Typ 2 – lateral third fractures
Typ 3 – fractures of the medial third Error creating thumbnail: 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
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