Abstract
Fractures of the distal clavicle represent 15–30% of all clavicle fractures. The local osseoligamentous anatomy and deforming forces result in increased risk of delayed union and nonunion than fractures in other parts of the clavicle. These factors also contribute to challenges in fracture repair. Understanding these injuries and their imaging features enhances care and ensures patients are directed to appropriate management. We review the anatomy of the distal clavicle and surrounding ligaments, options for radiographic evaluation, relevant classification systems, and current concepts in management. Illustrative examples of specialized views are provided. Pediatric acromioclavicular joint pseudosubluxation is also reviewed, with findings specific to that injury.
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References
Nordqvist A, Petersson C (1994) The incidence of fractures of the clavicle. Clin Orthop Relat Res 300:127–132
O’Neill BJ, Hirpara KM, O’Briain D, McGarr C, Kaar TK (2011) Clavicle fractures: a comparison of five classification systems and their relationship to treatment outcomes. Int Orthop 35(6):909–914. https://doi.org/10.1007/s00264-010-1151-0
Robinson CM (1998) Fractures of the clavicle in the adult: epidemiology and classification. J Bone Joint Surg Br 80B:476–484
Robinson M, Cairns DA (2004) Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg 86A(4):778–782
Renfree KJ, Riley MK, Wheeler D, Hentz JG, Wright TW (2003) Ligamentous anatomy of the distal clavicle. J Shoulder Elb Surg 12(4):355–359. https://doi.org/10.1016/s1058-2746(03)00029-6
Kumar R, Madewell JE, Swischuk LE, Lindell MM, David R (1989) The clavicle: normal and abnormal. Radiographics 9(4):677–706. https://doi.org/10.1148/radiographics.9.4.2756192
Bearden JM, Hughston JC, Whatley GS (1973) Acromioclavicular dislocation: method of treatment. J Sports Med 1(4):5–17. https://doi.org/10.1177/036354657300100401
Neer CS (1968) Fractures of the distal third of the clavicle. Clin Orthop Relat Res 58:43–50
Yap JJL, Curl LA, Kvitne RS, McFarland EG (1999) The value of weighted views of the acromioclavicular joint. Am J Sports Med 26(6):806–809
Postacchini F, Gumina S, De Santis P, Albo F (2002) Epidemiology of clavicle fractures. J Shoulder Elb Surg 11(5):452–456. https://doi.org/10.1067/mse.2002.126613
Allman FL (1967) Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am 49(4):774–784. https://doi.org/10.2106/00004623-196749040-00024
Craig EV (1996) Fractures of the clavicle. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD (eds) Rockwood and Green’s fractures in adults. Lippincott-Raven, Philadelphia, pp 1109–1161
Neer CS (1984) Fractures of the clavicle. In: Rockwood CA, Green DP, Wilkins KE, King RE (eds) Fractures in adults: fractures in children. J. B Lippincott, Philadelphia, pp 707–712
Neer CS (1963) Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma 3(2):99–110. https://doi.org/10.1097/00005373-196303000-00001
Jackson WF, Bayne G, Gregg-Smith SJ (2006) Fractures of the lateral third of the clavicle: an anatomic approach to treatment. J Trauma 61(1):222–225. https://doi.org/10.1097/01.ta.0000196804.23024.a3
Bishop JY, Jones GL, Lewis B, Pedroza A, Group MS (2015) Intra- and interobserver agreement in the classification and treatment of distal third clavicle fractures. Am J Sports Med 43(4):979–984. https://doi.org/10.1177/0363546514563281
Clavicle (2018). J Orthop Trauma 32 Suppl 1:S105. doi:https://doi.org/10.1097/BOT.0000000000001056
Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE (2004) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg 86A:1359–1365
Taylor AR (1969) Some observations on fractures of the clavicle. Proc R Soc Med 62(10):1037–1038
Hill JM, McGuire MH, Crosby LA (1997) Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 79B(4):537–539
McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, Wild LM, Potter J (2006) Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg 88-A(1):35–40
McKee MD, Wild LM, Schemitsch EH (2003) Midshaft malunions of the clavicle. J Bone Joint Surg Am 85A:790–797
Society COT (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89A(1):1–10. https://doi.org/10.2106/JBJS.F.00020
Virtanen KJ, Malmivaara AO, Remes VM, Paavola MP (2012) Operative and nonoperative treatment of clavicle fractures in adults. Acta Orthop 83(1):65–73. https://doi.org/10.3109/17453674.2011.652884
Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD (2005) Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures. J Orthop Trauma 19(7):504–507. https://doi.org/10.1097/01.bot.0000172287.44278.ef
Falstie-Jensen S, Mikkelsen P (1982) Pseudodislocation of the acromioclavicular joint. J Bone Joint Surg 64B(3):368–369
Black GB, McPherson JA, Reed MH (1991) Traumatic pseudodislocation of the acromioclavicular joint in children. A fifteen year review. Am J Sports Med 19(6):644–646. https://doi.org/10.1177/036354659101900616
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Sandstrom, C.K., Gross, J.A. & Kennedy, S.A. Distal clavicle fracture radiography and treatment: a pictorial essay. Emerg Radiol 25, 311–319 (2018). https://doi.org/10.1007/s10140-018-1586-y
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DOI: https://doi.org/10.1007/s10140-018-1586-y