Clavicle fracture treatment pdf merge

This type of fracture is fairly commonaccounting for about 5 percent of all adult fractures. The goal of clavicle fracture treatment is to achieve bony union while minimizing dysfunction, morbidity, and cosmetic deformity. The most common type, accounting for 8085% of clavicle fractures in both children and adults as this is the weakest part of the bone presentation. Pdf clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466% of all shoulder fractures 2 find, read. A fall onto the lateral shoulder most frequently causes a clavicle fracture. These fractures make up between 21 and 28% of clavicle fractures, 1 though some estimate this percentage to be lower. Proprionibacterium acnes infection complicating the operative.

Surgically, which is required when the fractured clavicle pieces are unaligned. The course of treatment typically depends on the type of fracture, because some fractures have a much better chance of healing without surgery than oth ers. Clavicle fractures, especially of the mid third, are an injury commonly seen in clinical practice, therefore, there is constant earnest discussion of the optimal approach to therapy. The majority of midshaft clavicle fractures can be treated nonoperatively with a sling for comfort followed by the gradual institution of motion as the pain subsides and fracture site. This leaflet gives you the advice and exercises to help your clavicle collar bone to recover after your fracture. The history and physical examination remain the primary means of diagnosing this injury. In this multicenter, prospective, randomized controlled trial, patients between 18 and 60 years old with a displaced midshaft clavicular fracture were randomized between nonoperative treatment and open reduction with internal plate. It is very important to keep your arm from moving to allow the clavicle to heal. Pdf clavicle fractures is there a standard treatment. Case report close treatment of acute unstable distal clavicle. Clavicle fractures represent a common injury of the shoulder girdle.

Even displaced fractures have been successfully managed without surgery. Surgical techniques for the stable fixation of clavicle fractures. Clavicle surgery is usually performed under general anesthesia. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. Epidemiology clavicle fractures account for approximately 2. Rehabilitation protocol adopted from the massachusetts. This injury is associated with highenergy trauma, and the mechanism is often similar to those described above for scj dislocation. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks. In addition to plate fixation, in the setting of atrophic. N2 fractures of the clavicle are relatively common injuries that can occur in patients of all ages. Physiotherapy department helping your clavicle to recover.

Clavicle fractures account for 35% of injuries to the shoulder girdle and generally occur after blunt traumas. Now that you are using your sling less, it is very important that you use your shoulder as normally as possible. A recent metaanalysis of 2,144 clavicle fractures contained 1,145 fractures treated conservatively, which resulted in a nonunion rate of 5. Clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466% of all shoulder fractures 2.

Displaced, clavicle fracture, mid shaft and plating. Ap 30 degree cephalic tilt classification allman classification group 1 middle fractures 80% of clavicle fractures group 2 distal fractures 15% of clavicle fractures types i. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. A fractured clavicle, or fractured collarbone, is a common sports injury that generally occurs from an impact to the shoulder of a fall on an outstretched arm. Mckee md and the canadian orthopaedic trauma society. The pectoralis major and deltoid originate from the clavicle and the trapezius inserts on it.

Clavicle fractures also result from abusive trauma. If you continue browsing the site, you agree to the use of cookies on this website. Plating versus intramedullary fixation for acute displaced midshaft. In babies, these fractures can occur during the passage through the birth canal. However, recent wellconducted studies demonstrate that plate fixation of displaced midshaft clavicle fractures may result in improved functional outcome and a lower rate of malunion and nonunion, compared. The most common place for an adult to break this bone is in the shaft, or middle third, of the bone. The fragments are held stable by the intact periosteal sheath. Clavicle fractures are very common injuries in adults 25% and children 1015% and represent the 4466% of all shoulder fractures. Plate fixation compared with nonoperative treatment for. The deforming forces these muscles can produce on clavicular fracture must be considered. Kevin shea, intermountain orthopaedics, boise, idaho the treatment for clavicle fractures continues to evolve in the united states and europe.

Most midshaft clavicle fractures generally unite with any method of immobilization. Symptoms clavicle fractures can be very painful and may make it hard to move your arm. Jul 15, 2014 fracture classification allman classification. Normally, a sling is applied to the arm for treatment of a fractured clavicle. Pdf treatment of clavicle fractures giovanni merolla. Midshaft clavicle fracture this occurs in seventyfive percent of clavicle fractures and is the most common. Pdf clavicle fractures, especially of the mid third, are an injury commonly seen in clinical practice. Clavicle fracture an overview sciencedirect topics. Anatomy the collarbone clavicle is located between the ribcage sternum and the shoulder blade scapula, and it connects the arm to the body. David geier is an orthopedic surgeon and sports medicine specialist in charleston, south carolina. This is a very common fracture that occurs in people of all ages.

Rarely, clavicle fractures can occur from a direct blow or from a fall on an outstretched. A clavicle fracture is also known as a broken collarbone. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Jan 31, 2011 fractures of the clavicle le kim trong md. In addition to plate fixation, in the setting of atrophic nonunion bone grafting often from the iliac crest. Numerous reports have described their operative treatment. An 810 cm skin incision was placed on the line joining sternal notch to. Fracture union usually progresses regardless of the treatment initiated. In these cases, the bones need to be moved and secured in order to heal properly. Clavicle fractures are common, and it is important for primary care physicians to be familiar with basic principles of evaluation and management in order to initiate treatment as well as discuss these injuries with patients and consulting orthopedic surgeons. Combining the surgical repair and rehabilitation protocol allowed the athlete to. Rehabilitation protocol adopted from the massachusetts general hospital sports physical therapy program and the american academy of orthopedic surgeons. Clavicle fractures are common injuries in young, active indi. Until recently clavicle fractures were solely the domain of non surgical management.

The classification and treatment of distal clavicle fractures depend on where the fracture occurs in relation to these ligaments. Anatomy the collarbone clavicle is located between the ribcage sternum and the shoulder blade scapula. Thirty patients were involved in light work and 10 were heavy manual workers. Treatment of midshaft clavicular delayed and nonunions. Most clavicular fractures occur in the midpart of the clavicle 80%, about 1215% are laterally localized and only a few fractures affect the medial part of the bone 5, 7, 8.

The primary outcome was evidence of nonunion at 1 year. Clavicle surgery may be needed if the fractured bones if the fractured pieces of bone are not in their correct, anatomical location. Group iii fractures, referred to as medial fractures, are less common and make up about 2 to 4% of all clavicle fractures. Clavicle fractures are most common in children and young adults, typically occurring in per sons younger than 25 years. Department of orthopaedic surgery, the 175th hospital of pla the affiliated southeast. This means that the bone remains correctly aligned. Pain and decreased shoulder mobility are frequent invalidating complaints in a clavicular delayed and nonunion. Clavicle fractures indications for operative treatment.

Factors that may increase the risk for a clavicle fracture include the newborn being large in size, the newborns shoulder getting stuck during delivery, or the use of tools to assist with the delivery. If immobilization is used as treatment you may have a visible bump in the area but if you had surgery to fix the clavicle fracture you will little to no visible bumps. Most common approximately 80% in both adults and children. When examining a patient with an acute clavicle fracture i typically look for the usual deformity of the. On occasion, a severe fracture, or what appears to be a mild fracture, will not heal properly. Radiographs confirm the diagnosis and aid in further. If the fracture is displaced the outer lateral side of the clavicle is usually pulled down due to the weight of the arm and the inner. It can be as simple as being badly displaced to a simple crack in the bone. Many times when someone has undergone clavicle fracture surgery they will heal faster than those who do not and use other methods to treat their clavicle fracture. The basic method to check for a clavicle fracture is by an xray of the clavicle to determine the fracture type and extent of injury.

Any nondisplaced distal clavicle fracture in a child type i, ii, or iii can be managed with sling immobilization for comfort and early rangeofmotion exercises as soon as pain permits. Fracture of the collar bone is a common birth injury. Clavicular fracture in a collegiate football player. These fractures may be partial or complete and often require surgical repair and immobilization while they heal. Forces sufficient for fracture can be inflicted by a direct blow to the shoulder or, alternatively, if the child is thrown or pushed and subsequently falls onto his or her shoulder figure 329.

If clavicle forms a slight sshaped curve where it curves from the sternal end laterally and anteriorly for near half its length, then forming a posterior curve to the acromion of the scapula. Surgical treatment in displaced fractures of the clavicle in our study produces. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it snaps or breaks. Evaluation of the xray should include the location of the fracture medial, middle, or lateral third, the amount of displacement a percentage of the clavicle shaft diameter, the amount of fracture shortening overlap, angulation and whether or not the fracture involves either the medial physis or lateral physis. Plate fixation versus nonoperative treatment for displaced. Ultrasoundguided combined interscalenecervical plexus. The original classification by neer in the 1960s described two types of distal clavicle fractures. Twenty new jersey and new york emergency departments from january, 2000 to february, 2007. However, the optimal treatment option for isolated acute displaced midshaft. Feb 03, 2020 care guide for clavicle fracture discharge care. In the setting of hypertrophic nonunion, increased stabilization with orif may be all that is required. This paper introduces a miniopen technique for the treatment of distal clavicle fractures neer type iib associated with ruptured coracoclavicular. Most surgeons prefer nonoperative treatment of nondisplaced midshaft clavicle fractures. A multicentre randomized controlled trial of nonoperative versus operative treatment of displaced clavicle shaft fractures.

Operative treatment of these fracture is usually considered for open injuries, and fractures with neurovascular compromise or overlying skin compromise 5, 6. Between 2006 and 2009, 18 patients of distal clavicle fracture were treated with mi. Clavicle collar bone fracture your clavicle is one of two long thin bones at the top of your chest. A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder.

Surgical treatment for clavicular fractures is becoming increasingly common. Pdf fractures of the clavicle are a common injury and most often occur in younger individuals. Presentation, evaluation, and treatment of clavicle fracture. At first your shoulder will feel stiff and painful but it is important that you continue to move it as this will aid your. Despite the high frequency the choice of proper treatment is still a challenge for the orthopedic surgeon.

If your clavicle fracture is good position, no surgery is required. Oroko and colleagues found that shortening of the clavicle had no functional impact in 41 patients when evaluated 3 or more months after clavicle fracture. It can happen when a person falls on an outstretched hand or onto a shoulder, or in. Mar 25, 20 clavicle nonunion autologous bonegraft not a necessary augment 15 patients with symptomatic nonunion after nonoperative treatment of a midshaft clavicle fracture of the clavicle hypertrophic nonunion had excessive callus morselized atrophic nonunion had freshening of ends of bone use of titanium precontoured plate all patients. This is largely because of reported nonunion rates of less than 1% and separate reports by neer40 and. Millett, md, msc steadman philippon research institute, vail, co, usa clavicle fractures are common in adults and children. Over onethird of clavicle fractures in males occur between the ages of and 20 years, while 20 percent of clavicle fractures in women occur in the same age group. Treatment consists of drainage of the hemothorax and conservative treatment or operative. Incidence and clinical significance, a 5year followup of 85 patients. We look at symptoms, causes and treatment including top tips on making a full recovery. Department of orthopedic surgery, shanghai sixth peoples hospital, jiaotong university, shanghai 200233. Clavicle fracture treatment, healing time, surgery. Clavicle fracture treatment, healing time, surgery, management. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on.

Historically, only unstable distal clavicle fractures were treated operatively. Clavicle fractures take the same time to heal with or without surgery. The distal most lateral fractures in children may be growth plate injuries and also need to be. Clavicle fracture, epidemiology, classification, treatment, the swedish fracture register background fractures of the clavicle, which primarily occur in young males, constitute 2. Clavicle collar bone fractures are the most common injury sustained by newborns during birth. Plate fixation is the primary treatment for symptomatic nonunion of a clavicle shaft fracture. This is a very common fracture that occurs in people of all ages, often related to sporting activity such as skiing and cycling. Clavicle fracture discharge care what you need to know. Hence, nonoperative treatment was the established and accepted modality. A clavicle fracture aka broken collarbone is a common shoulder injury. Surgical treatment for unstable distal clavicle fracture with. Its superficial location, its thin midshaft, and the forces trans. Clavicle fractures are a very common injury in the pediatric and adult populations.

This prevents displacement and makes type ii fractures in children more stable than in adults. Most clavicle fractures heal nicely with conservative, nonsurgical treatment. Give parent fracture of the clavicle collarbone fact sheet. Medial clavicle fracture may occur in patients of any age and include less than 5% of all clavicle fractures. The emphasis of this article is on the management of these injuries. Sagging shoulder down and forward inability to lift the arm because of pain.

With a simple arm sling to keep the clavicle pieces in place, the fracture can heal naturally without the need for invasive treatments. Jan 01, 2008 the usual mechanism of a clavicle fracture is a fall directly on the shoulder with the arm at the side. Consecutive patients younger than 2 years with the primary or secondary diagnosis of clavicle fracture according to the international classification of diseases, ninth revision. For displaced clavicle fractures with greater than 2 cm of shortening, current recommendation is operative management with open reduction and internal fixation 1, 2. The nonunion rate after closed fracture treatment has been reported to be from 0. Historically, the vast majority of clavicle fractures have been treated nonoperatively in the acute setting. The collar bone, or clavicle, is the bone running from the breast bone to the shoulder. The clavicle overlies the brachial plexus, as well as the jugular and subclavian blood vessels. Rehabilitation protocol adopted from the massachusetts general hospital sports physical therapy program and the american academy of orthopedic surgeons for nonsurgical rehabilitation of clavicle fractures 7,15. Clavicle fracture broken collarbone a broken collarbone is also known as a clavicle fracture. Jan 14, 2019 clavicle fractures are common and easily recognized because of their subcutaneous position, as shown in the images below. Nonoperative treatment of midshaft clavicle fractures in.

Department for orthopaedic and trauma surgery, albertludwigsuniversity of freiburg, medical school, freiburg im. The aim was to analyze whether patients with a displaced midshaft clavicular fracture are best managed with plate fixation or nonoperative treatment with respect to nonunion, secondary operations, and functional outcome, by evaluating all available randomized controlled trials rcts on this subject. Usually, the breaks heals in around 68 weeks but it is fairly common that it can take up to 3 months. Fractures of the midthird of the clavicle do well with nonoperative treatment, except for those in which the fracture is displaced posteriorly.

The peak incidence occurs in children and young adults. Clavicle fracture broken collarbone orthoinfo aaos. After full recovery prescribe special exercises for clavicle fracture, help restore lost muscle mass and motor activity of the hands. Newborn clavicle fractures nationwide childrens hospital. Adapted from zlowodzki m, zelle ba, cole pa, et al. The trauma mechanism of clavicle fractures is typically induced by a direct blow to the shoulder, rather than. You may be given contrast liquid to help the fracture show up better in the pictures. With timely treatment to a qualified specialist term complete healing of a broken clavicle and reconstruction of the hand can reach up to eight weeks. With this treatment, the fractured pieces are screwed to a metal plate to keep them in place during the healing process. Children under eleven years with undisplaced clavicle bone fractures do not require followup with a doctor or xray. Once the fracture heals, this special plate may be removed. Brachial plexus injury about 1% of brachial plexus injuries occur following a. Treatment will depend on the damage and the kind of fracture you have. If displaced, the lateral fragment is usually pulled down by weight of limb and the medial fragment tends to be displaced upwards by the action of the sternocleidomastoid muscle.