- See: 
- Clavicular Frx in Children / Congential Pseudoarthrosis of Clavicle
- AC joint / Sternoclavicular Joint Injury / Scapula Fracture
- Discussion and Classification
- Exam Findings:
- brachial plexus
- ref: Injury to the brachial plexus by a fragment of bone after fracture of the clavicle
- Radiology: 
- Serendipity View
- best visualized w/ AP view & view w/ beam angled 30 deg. cephalad;
- w/ frx of clavicle, distal fragment & arm tend to sag, while proximal fragment, held by SC joint tends to point upward;
- in any clavicular frx, carefully scutinize x-rays for presence of scapular frx, which represents a floating shoulder;
- Non Operative Treatment:
- it is difficult to reduce and maintain the reduction of clavicle fractures;
- despite deformity, healing usually proceeds rapidly;
- union usually occurs rapidly & produces prominent callus; 
- w/ midshaft fractures, there will also be some degree of malunion;
- in these patients be attentive to medial cord nerve symptoms (more often ulnar nerve);
- distal clavicle fractures may have a high incidence of non union but most of these are asymptomatic, and of these only a
small number will be severe enough to require surgery;
- references:
- Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling.
- Recovery following fractures of the clavicle treated conservatively.
- Primary Nonoperative Treatment of Displaced Lateral Fractures of the Clavicle.
- Closed treatment of displaced middle-third fractures of the clavicle gives poor results.
- Estimating the Risk of Nonunion Following Nonoperative Treatment of a Clavicular Fracture.
- Deficits Following Nonoperative Treatment of Displaced Midshaft Clavicular Fractures.
- Shortening of clavicle after fracture. Incidence and clinical significance, a 5-year follow-up of 85 patients.
- Operative Versus Nonoperative Treatment of Midshaft Clavicle Fractures in Adolescents
- Operative Treatment /
Intramedullary Pin Fixation
- Non Union and Malunion of the Clavicle:
- defined as absence of radiographic healing by 4 months;
- non unions occur in more severe traumatic injuries;
- occurs most often in the central third where the clavicle lacks abundant muscular coverage;
- in mid-clavicular region, deforming forces include pectoralis major (pulls distal fragment inferiorly and medially) and sternocleidmastoid (pulled superiorly);
- note that the diagnosis of clavicular non union can sometimes be difficult (because 2 orthogonal views cannot be obtained), and the supermposed ends of the clavicle on the AP view can give the false impression of union;
- exam:
- note function of
brachial plexus (esp lower trunk);
- r/o presence of
thoracic outlet syndrome;
- management:
-
intra-medullary clavicular fixation:
-
iliac crest bone grafting;
- internal or external bone stimulator;
- references:
-
Nonunion of the clavicle and thoracic outlet syndrome.
-
Non-union of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting.
-
Non-union of the clavicle. Associated complications and surgical management.
-
The operative treatment of mid-shaft clavicular non-unions.
-
Surgery for ununited clavicular fracture.
-
The treatment of nonunion fractures of the midshaft of the clavicle with an intramedullary Hagie pin and autogenous bone graft.
-
Midshaft Malunions of the Clavicle.
-
Short malunions of the clavicle: an anatomic and functional study
-
Brachial Plexus Palsy Secondary to Clavicular Nonunion.
- References:
Osteolysis of the distal part of the clavicle in male athletes.
Condensing osteitis of the clavicle. A review of the literature and report of three cases.
Atlanto-axial rotatory fixation and fracture of the clavicle. An association and a classification.
