By Marco Castenetto 7 January 2023 0 Comments Orthopedics

The essential guide to clavicle fracture

Clavicle fracture is the most common injury during birth (accounting for 40 to 50% of all injuries).

This type of bone tends to heal spontaneously faster than any other.

They are common injuries in young, active individuals, especially those who participate in activities or sports in which high-speed falls (eg, bicycle, motorcycle) or violent collisions (eg, soccer, hockey) are common.

They account for approximately 2.6% of all fractures (1).

Clavicle fracture mechanism:

A direct blow to the shoulder is the most commonly documented mechanism of injury that produces a clavicle fracture.

This can occur in a number of ways, including falling from a speeding vehicle or bicycle, during a sporting event, an automobile/motorcycle accident, sports injury, or from falling from a height, such as in skiing and snowboarding.

What are the main areas where a clavicle fracture may occur:

The highest percentage of clavicle fracture occurs at the middle third junction (85%);
A very small percentage at the proximal end of the clavicle (5%);
Distal extremity fracture is rare (10%).

How to spot a clavicle fracture:

At first you may perceive:

A lot of pain;
Swelling;
Deformity and inability to lift the shoulder.

Rarely, a pseudo-paralysis of the affected arm may also occur.

The fracture fragment closest to the neck (proximal fragment) is displaced superiorly, becoming visible and palpable.

The lateral fragment, on the other hand, tends to fall due to the weight of the arm and the traction of the pectoralis major.

Particular care should be taken in children, because the fracture fragment is not always visible.

$proximal-and-lateral-fragment-displacement-in-clavicle-fractures$

In particular, in displaced clavicle fractures, you may find yourself assuming a specific position defined as “defense position”, in which the contralateral hand (the opposite one) supports the elbow of the damaged limb, and the head tends to incline towards the fractured area, causing the muscular structures that intervene on the clavicle to decrease its functionality.

The body tends to assume this position automatically, to avoid a greater breakdown of bone fragments, which could cause greater injuries, as well as an increase in perceived pain.

$defense-position-a-person-assumes-after-a-bone-fracture$

Possible complications following a clavicle fracture:

Immediate complications:

They are rare, but can also be very serious, such as lung and pleural lesions (the layer that covers the lungs).

Late complications:

Pseudoarthrosis;
Vicious union (visible due to a swelling on the clavicle, due to excessive formation of bone callus);
Vascular and nerve compressions (both structures pass posteriorly to the clavicle, moreover, the bone morphology can change following a fracture, and a skeletal malunion could be “encumbrance” by compressing the bundle of nerves of the brachial plexus and the subclavian vein which, starting from the neck, reach the extremities of the upper limbs).

What therapies are used to heal a clavicular fracture:

$Anatomy-of-the-subclavian-vein-and-brachial-plexus-in-clavicle-fractures$

Conservative treatment:

In children (and infants) bone healing is spontaneous.

Cuff and collar sling for non-displaced clavicle fractures;

The figure-8 bandage is commonly used and works by retracting the shoulder girdle, minimizes the overlap and allows a better anatomical healing.

Surgical treatment:

It is indicated in case of bone displacements, in exposed fractures and consists in an open reduction and rigid internal fixation.

Common methods of internal fixation are:

Intramedullary fixation with Kirschner wires;
Rigid plate and screw fixation with semitubular or pelvic AO reconstruction plate.

$clavicle fracture operation by osteosynthesis of bone fragments with plate and screws$

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The essential guide to clavicle fracture

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