There is no long-term benefit to surgical management over a conservative approach
- Common injury often in children and young adults
- Also seen in the elderly with osteoporosis and falls
- Fall onto an outstretched upper limb or hand
- Direct blow to the clavicle or indirect through the shoulder joint.
- Type I: Middle third of the clavicle. Commonest. The middle is weakest. usually stable despite deformity.
- Type II: Lateral third of the clavicle. If displaced, these types are often unstable
- Type III: Medial third: Uncommon but may be seen with severe trauma and may be associated with mediastinal or other injuries as well as pneumothorax, or haemothorax
- Localised pain over the shoulder and upper arm
- Swelling over clavicle and shoulder and front of the chest
- Sharp pain when any movement is made
- Possible nausea, dizziness, and/or spotty vision due to extreme pain
- X-ray of the clavicle to determine the fracture type and extent of the injury.
- CT or MRI may be used if in doubt
- Assess clinically: If Posterior displacement CT chest
- Ultrasound may be equally accurate in children
- Non-union is a major complication of clavicle fractures. Usually lateral clavicular fractures
- Infection, Haemorrhage
- Medial fractures may have Posterior displacement - mediastinal injury and Nerve injury and should be referred to ortho
- Analgesia and tetanus if skin break. Open fractures may need surgery. Medial fractures may need exclusion of other injuries with CT chest.
- Generally a broad arm sling is applied and generally kept on until the patient regains pain-free movement of the shoulder.
- Conservative: use of a splint or sling to keep the joint stable and decrease the risk of further damage. Usually, a figure-of-eight splint that wraps the shoulders to keep them forced back is used and the arm is placed in a clavicle strap for comfort. Provide a sling, and pain relief, and to allow the bone to heal itself, monitoring progress with X-rays every week or few weeks. Resulting bony prominence may take months/years to remodel
- Surgery is employed in 5 to 10% of cases. If the fracture is at the lateral end, the risk of nonunion is greater than if the fracture is of the shaft. A comminuted fracture may need treated with an intramedullary fixation device. Surgery if there is a skin break or any neurovascular involvement or distal third fractures (high risk of nonunion)