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Clavicle Fractures

- See: 
- Clavicular Frx in ChildrenCongential 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 sitting up 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;
- references:
- Upright versus supine radiographs of clavicle fractures: does positioning matter?

- 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
              - Pediatric refracture rates after angulated and completely displaced clavicle shaft fractures.
- Arteriovenous Fistula Development After Nonoperative Treatment of a Clavicular Fracture
- Arteriovenous Fistula Development After Nonoperative Treatment of a Clavicular Fracture. A Case Report
- Dynamic Compression of the Subclavian Artery Secondary to Clavicle Nonunion. A Report of 2 Cases

- 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
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 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.