Large multicentre studies of clavicle fractures have so far been missing. Philadelphia, pa, lippincottraven, 1996, pp 11091193. This type of fracture is fairly commonaccounting for about 5 percent of all adult fractures. In fourteen cases, the fracture was in the middle third, while in six it was in the outer third. Eskola a, vainionpaa s, myllynen p, patiala h, rokkanen p. Treatment of ununited fractures of the scaphoid by iliac. Fractures of the middle third of the clavicle may be more prone to nonunion. Kreher, md, boston university, boston, massachusetts c lavicle fractures constitute 5 patient. Pdf clavicle fractures is there a standard treatment. Europe pmc is an archive of life sciences journal literature. Nonsurgical and surgical management provide similar results. Fracture union usually progresses regardless of the treatment initiated.
Weakness, numbness, or tingling in your shoulder and arm. Thank you for your interest in spreading the word about the bmj. Clavicular fractures, clavicle epidemiology, clavicle malunion. Whilst they may be very painful, clavicle injuries are rarely serious and in most cases are managed.
It articulate with sternum medially to form sternoclavicular joint. Rehabilitation protocol adopted from the massachusetts. These fractures sometimes result in longterm complications, such as chronic pain and swelling. It has not proved possible to predict the position of a clavicle fracture from the mechanism of injury alone. Neer type i fractures, 23 dislocated type ii fractures there were 10 nonunions, 8 of these asymptomatic. Get information on broken collarbone clavicle symptoms in newborns, children, teens, adults, and the elderly such as pain and bruising at the site of the fracture. The aim of this observational study was to describe the epidemiology, classification and treatment of clavicle fractures in the the swedish fracture register sfr that collects national prospective data from large fracture populations. Surgical options to achieve bony union include transacromial wire fixation, a modified weaverdunn. The clavicle bone lies just beneath the skin, so a fracture usually causes an obvious protrusion or bump at the fracture site, along with swelling. Treatment of ununited fractures of the scaphoid by iliac bone grafts and kirschnerwire fixation by herbert h.
After open reduction and internal plate fixation, all symptoms were resolved and complete consolidation of the. Surgery for ununited clavicular fracture 367 was nonunited. Simple pain medication is often needed, and should be given regularly until comfortable. Fractures can involve the midshaft approximately 70%, lateralend 28%, andor medialend 23% of the clavicle and are typically caused by a fall on an. Despite the name, the collarbone isnt really in your neck. The patients who seemed to have a predilection to nonunion were seven who had sustained a refracture and twentyone who had had severe trauma.
Ununited fracture definition of ununited fracture by. Adolescent displaced midshaft clavicle fracture journal of hand. Pain at the clavicle or top of the shoulder, especially with shoulder movement. First aid, treatment, and recovery time for a broken collarbone is provided. Deformity in repaired bones is the result of poor position holding. An arm sling should be worn for comfort for two to three weeks figure 2. Section on orthopedic surgery, the mayo clinic fellow in orthopedic surgery, the mayo foundation and james h. The clavicle overlies the brachial plexus, as well as the jugular and subclavian blood vessels. Even displaced fractures have been successfully managed without surgery.
Publications home of jama and the specialty journals of. Clavicle fractures are common and easily recognized because of their subcutaneous position, as shown in the images below. Pdf fractures of the clavicle are a common injury and most often occur in younger individuals. Fractures of the clavicle, in rockwood ca jr, et al, eds. Outcome of surgical fixation of complex clavicular. Twentyfour ununited, primarily conservatively treated clavicular fractures were treated operatively. Millett, md, msc steadman philippon research institute, vail, co, usa clavicle fractures are common in adults and children. It is a matter of selection, after excision of joints or resection of bones, whether nails are selected to secure the bones, or whether wire is used. The femur is the seat of many cases of nonunion which are found in the middle third of the shaft or, in elderly persons, in the neck of the femur. The fracture generally occurs in the middle of the bone figure 1. The factors predisposing to pseudarthrosis were severe trauma with persistent gross displacement of the fragments, primary open reduction with inadequate internal fixation, and insufficient external fixation. The deforming forces these muscles can produce on clavicular fracture must be considered. Ununited fracture of the outer third of the clavicle. The natural repair of fractures among birds is doubtless very rapid but depends upon the amount of disturbance.
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. To arrive at the top five similar articles we use a wordweighted algorithm to compare words from the title and abstract of each citation. A clavicle fracture, aka broken collar bone, is a common injury usually caused a fall, direct blow or car accident. Although we report a considerable number of patients, the sample size is not sufficient for subgroup analysis. In my practice as a shoulder and elbow specialist, it is the most commonly fractured bone seen in the clinic. Clavicle fractures are very common injuries in adults 25% and children 1015 % 1 and represent the 4466% of all shoulder fractures 2. A clavicle fracture is a break in your clavicle collarbone. Fellow in orthopedic surgery, the mayo foundation rochester, minnesota it is unusual for a fracture of the clavicle to result in nonunion. A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. Nine patients had subjective weakness of abduction. Section on orthopedic surgery, the mayo clinic rochester, minnesota ununited fractures may be divided into two groups. Clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466% of all shoulder fractures 2. Ununited fractures of the clavicle pubmed central pmc. Group i includes fractures of the middle one third, the most frequent site.
The most common place for an adult to break this bone is in the shaft, or middle third, of the bone. Complications can include a collection of air in the pleural space surrounding the lung pneumothorax, injury to the nerves or blood vessels in the area, and an unpleasant. Possibly i am stating the facts, when the statement is made that the majority of surgeons prefer spikes to wire. In all cases, the primary displacement was at least equal to the clavicular thickness. Is an sshape long, curved,tubular bone, lies horizontally a cross the root of neck.
In four of these pa tients, radiographic examination revealed shortening of the clavicle, and one also had limitation of abduction. The pectoralis major and deltoid originate from the clavicle and the trapezius inserts on it. The problem of the ununited fracture sciencedirect. Medical memorandum ununited fractures of the clavicle br med j 1952. The inner end of the clavicle joins the sternum breastbone. A 49yearold man with a 15yearold nonunion of a midshaft clavicle fracture suffered from progressive tingling in his entire arm and fingers for two years, due to irritation of the brachial plexus in the costoclavicular space, especially upon elevation of the arm. Anatomy the collarbone clavicle is located between the ribcage sternum and the shoulder blade scapula, and it connects the arm to the body. Clavicle fractures also called simply broken collarbones are a familiar woe to many athletes. Broken collarbones are most common in children in young adults. The decision whether to operate may be influenced by the amount of fracture displacement and the individual demands of the patient.
Calcaneus heel bone fractures typically occur during a highenergy eventsuch as a car crash or a fall from a ladderwhen the heel is crushed under the weight of the body. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Clavicle fracture broken collarbone a broken collarbone is also known as a clavicle fracture. It largely remains unknown how many ununited clavicle fracture treated initially with open reduction and internal fixation are due to an underlying infection.
The collar bone is the most commonly fractured bone in the body. Clavicle fracture is a common injury in all age groups. The most common way to fracture the clavicle is through a fall or direct blow to the area, often after a fall from a bike, a football injury or soccer injury. Twentyfour ununited, primarily conservatively treated clavicular frac tures were. Until recently clavicle fractures were solely the domain of non surgical management. The subjective outcome was good in 17 cases, satisfactory in six, and poor in one.
The main indications for grafting were an ununited fracture with disabling pain in 107 patients. Links to pubmed are also available for selected references. Severe initial injuries and improper immobilization would appear to be the chief causes of nonunion in this type of fracture. This is a very common fracture that occurs in people of all ages. The clavicle is one of the most commonly fractured bones. Fractured clavicle the student health provider has diagnosed a fracture break of your clavicle collarbone. The plaintiff was rendered unconscious and unaware for four days following and as a result of the collision. Nonunion clavicular fractures treated with anatomical locking.
However, from the time the fracture initially occurs to the time the fracture heals, many complications can occur. Rehabilitation protocol adopted from the massachusetts general hospital sports physical therapy program and the american academy of orthopedic surgeons. Statistics show that ununited fractures occur most frequently in the tibia, humerus, ulna and radius. A clavicle fracture is typically associated with extreme pain, and arm movement is difficult. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. Clavicle fracture broken collarbone orthoinfo aaos. The first page of the pdf of this article appears above. Typically a midshaft clavicle fracture occurs from a fall directly on the point of the shoulder. In five patients the ra diographic and clinical findings were normal.
Injuries of shoulder girdle clavicle fracture scapula fracture 2. A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. Clavicle fractures matthew pecci, md, and jeffrey b. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
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