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Nonoperative Clavicle Fractures

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Abstract

Clavicle fractures account for 2.6–5% of all fractures treated by orthopedic practitioners (Clin Orthop Relat Res (300):127–32, 1994; J Shoulder Elb Surg 11(5):452–6, 2002). Appropriate radiographic evaluation of clavicle fractures is paramount in developing a plan of care. Today, widely accepted indications for nonoperative management in adults are nondisplaced or minimally displaced midshaft clavicle fractures and patients who are poor surgical candidates based on medical comorbidities. The optimal treatment of fractures that lie outside these indications is more controversial. All patient factors including baseline activity level, handedness, fracture pattern, patient expectation, mechanism of injury, and risk factors for nonunion should be evaluated and discussed with the patient. Nonoperative management relies on immobilization for 2–6 weeks with either sling or figure of eight brace while monitoring radiographs. Patients should be counseled that, in most cases, nonoperative management will provide a successful outcome; however, some may require delayed surgery for symptomatic nonunion or malunion. The patient and physician must discuss treatment options and come to a mutually acceptable treatment plan.

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Abbreviations

AP:

Anteroposterior

ASES:

American shoulder and elbow surgeon

DASH:

Disability of arm shoulder and hand

References

  1. Adams F. The genuine works of Hippocrates, translated from the Greek. Baltimore: Williams & Wilkins; 1939. p. 216–7.

    Google Scholar 

  2. Dupuytren G. On injuries and disease of bone. Selections from the collected edition of the clinical lectures of Baron Dupuytren [Internet]. 1847. p. 97–8. https://books.google.com/books?id=2XYFAAAAQAAJ&;pg=PA97&source=gbs_toc_r&cad=3#v=onepage&q&f=false

  3. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;(300):127–32.

    Google Scholar 

  4. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elb Surg. 2002;11(5):452–6.

    Article  Google Scholar 

  5. Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma. 2015;29(8):e242–4.

    Article  PubMed  Google Scholar 

  6. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80(3):476–84.

    Article  CAS  PubMed  Google Scholar 

  7. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury. 2000;31(5):353–8.

    Article  CAS  PubMed  Google Scholar 

  8. Ludewig PM, Behrens SA, Meyer SM, Spoden SM, Wilson LA. Three-dimensional clavicular motion during arm elevation: reliability and descriptive data. J Orthop Sports Phys Ther. 2004;34(3):140–9.

    Article  PubMed  Google Scholar 

  9. Sahara W, Sugamoto K, Murai M, Yoshikawa H. Three-dimensional clavicular and acromioclavicular rotations during arm abduction using vertically open MRI. J Orthop Res. 2007;25(9):1243–9.

    Article  PubMed  Google Scholar 

  10. Ljunggren AE. Clavicular function. Acta Orthop Scand. 1979;50(3):261–8.

    Article  CAS  PubMed  Google Scholar 

  11. Taitsman LA, Nork SE, Coles CP, Barei DP, Agel J. Open clavicle fractures and associated injuries. J Orthop Trauma. 2006;20(6):396–9.

    Article  PubMed  Google Scholar 

  12. Jeray KJ. Acute midshaft clavicular fracture. J Am Acad Orthop Surg. 2007;15(4):239–48.

    Article  PubMed  Google Scholar 

  13. Malcolm BW, Ameli FM, Simmons EH. Pneumothorax complicating a fracture of the clavicle. Can J Surg. 1979;22(1):84.

    CAS  PubMed  Google Scholar 

  14. Williams RJ. Significant pneumothorax complicating a fractured clavicle. J Accid Emerg Med. 1995;12(3):218–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Dugdale TW, Fulkerson JP. Pneumothorax complicating a closed fracture of the clavicle. A case report. Clin Orthop Relat Res. 1987;221:212–4.

    Google Scholar 

  16. Dath R, Nashi M, Sharma Y, Muddu BN. Pneumothorax complicating isolated clavicle fracture. Emerg Med J. 2004;21(3):395–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hani R, Ennaciri B, Jeddi I, El Bardouni A, Mahfoud M, Berrada MS. Pneumothorax complicating isolated clavicle fracture. Pan Afr Med J. 2015;21:202.

    PubMed  PubMed Central  Google Scholar 

  18. Barbier O, Malghem J, Delaere O, Vande Berg B, Rombouts JJ. Injury to the brachial plexus by a fragment of bone after fracture of the clavicle. J Bone Joint Surg Br. 1997;79(4):534–6.

    Article  CAS  PubMed  Google Scholar 

  19. Yates DW. Complications of fractures of the clavicle. Injury. 1976;7(3):189–93.

    Article  CAS  PubMed  Google Scholar 

  20. Leffert RD, Seddon H. Infraclavicular brachial plexus injuries. J Bone Joint Surg Br. 1965;47:9–22.

    CAS  PubMed  Google Scholar 

  21. Howard FM, Shafer SJ. Injuries to the clavicle with neurovascular complications. A study of fourteen cases. J Bone Joint Surg Am. 1965;47(7):1335–46.

    Article  CAS  PubMed  Google Scholar 

  22. Chen DJ, Chuang DC, Wei FC. Unusual thoracic outlet syndrome secondary to fractured clavicle. J Trauma. 2002;52(2):393–8; discussion 398–9.

    Google Scholar 

  23. Kendall K, Burton J, Cushing B. Fatal subclavian artery transection from isolated clavicle fracture. J Trauma. 2000;48(2):316–8.

    Article  CAS  PubMed  Google Scholar 

  24. Natali J, Maraval M, Kieffer E, Petrovic P. Fractures of the clavicle and injuries of the sub-clavian artery. Report of 10 cases. J Cardiovasc Surg (Torino). 1975;16(5):541–7.

    CAS  PubMed  Google Scholar 

  25. Harris JD, Latshaw JC. Improved clinical utility in clavicle fracture decision-making with true orthogonal radiographs. Int J Shoulder Surg. 2012;6(4):130–4.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Backus JD, Merriman DJ, McAndrew CM, Gardner MJ, Ricci WM. Upright vs. supine radiographs of clavicle fractures: does positioning matter? J Orthop Trauma. 2014;28(22):636–41.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Plocher EK, Anavian J, Vang S, Cole PA. Progressive displacement of clavicular fractures in the early postinjury period. J Trauma. 2011;70(5):1263–7.

    Article  PubMed  Google Scholar 

  28. Riehl JT, Athans BJ, Munro MW, Langford JR, Kupiszewski SJ, Haidukewych GJ, et al. Minimally displaced clavicle fracture after high-energy injury: are they likely to displace? Can J Surg. 2014;57(3):169–74.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86-A(7):1359–65.

    Article  PubMed  Google Scholar 

  30. Eskola A, Vainionpää S, Myllynen P, Pätiälä H, Rokkanen P. Outcome of clavicular fracture in 89 patients. Arch Orthop Trauma Surg. 1986;105(6):337–8.

    Article  CAS  PubMed  Google Scholar 

  31. Wick M, Müller EJ, Kollig E, Muhr G, Müller MWEJ, Muhr EKG. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg. 2001;121(4):207–11.

    Article  CAS  PubMed  Google Scholar 

  32. Liu W, Xiao J, Ji F, Xie Y, Hao Y. Intrinsic and extrinsic risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures. Orthop Traumatol Surg Res. 2015;101(2):197–200.

    Article  CAS  PubMed  Google Scholar 

  33. Murray IR, Foster CJ, Eros A, Robinson CM. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg Am. 2013;95(13):1153–8.

    Article  CAS  PubMed  Google Scholar 

  34. Neer CS, Rockwood CA. Fractures in adults. In: Rockwood C, Green D, editors. Fractures in adults. 2nd ed. Philadelphia: Lipincott; 1984. p. 711.

    Google Scholar 

  35. Andersen K, Jensen PO, Lauritzen J. Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling. Acta Orthop Scand. 1987;58(1):71–4.

    Article  CAS  PubMed  Google Scholar 

  36. Ersen A, Atalar AC, Birisik F, Saglam Y, Demirhan M. Comparison of simple arm sling and figure of eight clavicular bandage for midshaft clavicular fractures: a randomised controlled study. Bone Joint J. 2015;97(11):1562–5.

    Article  PubMed  Google Scholar 

  37. Zura R, Mehta S, Della Rocca GJ, Jones J, Steen RG. A cohort study of 4,190 patients treated with low-intensity pulsed ultrasound (LIPUS): findings in the elderly versus all patients. BMC Musculoskelet Disord. 2015;16:45.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF. Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. J Bone Joint Surg Am. 1994;76(1):26–34.

    Article  CAS  PubMed  Google Scholar 

  39. Emami A, Petrén-Mallmin M, Larsson S. No effect of low-intensity ultrasound on healing time of intramedullary fixed tibial fractures. J Orthop Trauma. 1999;13(4):252–7.

    Article  CAS  PubMed  Google Scholar 

  40. Lubbert PH, van der Rijt RH, Hoorntje LE, van der Werken C. Low-intensity pulsed ultrasound (LIPUS) in fresh clavicle fractures: a multi-centre double blind randomised controlled trial. Injury. 2008;39(12):1444–52.

    Article  PubMed  Google Scholar 

  41. Griffin XL, Smith N, Parsons N, Costa ML. Ultrasound and shockwave therapy for acute fractures in adults. Cochrane Database Syst Rev. 2012;2:CD008579.

    Google Scholar 

  42. Ebrahim S, Mollon B, Bance S, Busse JW, Bhandari M. Low-intensity pulsed ultrasonography versus electrical stimulation for fracture healing: a systematic review and network meta-analysis. Can J Surg. 2014;57(3):E105–18.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Nolte PA, van der Krans A, Patka P, Janssen IM, Ryaby JP, Albers GH. Low-intensity pulsed ultrasound in the treatment of nonunions. J Trauma. 2001;51(4):693–702; discussion 702–3.

    Google Scholar 

  44. Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am. 2013;95(17):1576–84.

    Article  CAS  PubMed  Google Scholar 

  45. Walton B, Meijer K, Melancon K, Hartman M. A cost analysis of internal fixation versus nonoperative treatment in adult midshaft clavicle fractures using multiple randomized controlled trials. J Orthop Trauma. 2015;29(4):173–80.

    Article  PubMed  Google Scholar 

  46. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am. 2012;94(8):675–84.

    Article  PubMed  Google Scholar 

  47. Kong L, Zhang Y, Shen Y. Operative versus nonoperative treatment for displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. Arch Orthop Trauma Surg. 2014;134(11):1493–500.

    Article  PubMed  Google Scholar 

  48. Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma. 1998;12(8):572–6.

    Article  CAS  PubMed  Google Scholar 

  49. Faldini C, Nanni M, Leonetti D, Acri F, Galante C, Luciani D, et al. Nonoperative treatment of closed displaced midshaft clavicle fractures. J Orthop Traumatol. 2010;11(4):229–36.

    Article  PubMed  PubMed Central  Google Scholar 

  50. McKee MD, Pedersen EM, Jones C, Stephen DJG, Kreder HJ, Schemitsch EH, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88(1):35–40.

    PubMed  Google Scholar 

  51. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19(7):504–7.

    Article  PubMed  Google Scholar 

  52. Manske DJ, Szabo RM. The operative treatment of mid-shaft clavicular non-unions. J Bone Joint Surg Am. 1985;67(9):1367–71.

    Article  CAS  PubMed  Google Scholar 

  53. Jupiter JB, Leffert RD. Non-union of the clavicle. Associated complications and surgical management. J Bone Joint Surg Am. 1987;69(5):753–60.

    Article  CAS  PubMed  Google Scholar 

  54. Karaharju E, Joukainen J, Peltonen J. Treatment of pseudarthrosis of the clavicle. Injury. 1982;13(5):400–3.

    Article  CAS  PubMed  Google Scholar 

  55. Boehme D, Curtis RJ, DeHaan JT, Kay SP, Young DC, Rockwood CA. Non-union of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting. J Bone Joint Surg Am. 1991;73(8):1219–26.

    Article  CAS  PubMed  Google Scholar 

  56. McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. J Bone Joint Surg Am. 2003;85(5):790–7.

    Article  PubMed  Google Scholar 

  57. Ledger M, Leeks N, Ackland T, Wang A. Short malunions of the clavicle: an anatomic and functional study. J Shoulder Elb Surg. 2005;14(4):349–54.

    Article  Google Scholar 

  58. Althausen PL, Shannon S, Lu M, O’Mara TJ, Bray TJ. Clinical and financial comparison of operative and nonoperative treatment of displaced clavicle fractures. J Shoulder Elb Surg. 2013;22(5):608–11.

    Article  Google Scholar 

  59. Pearson AM, Tosteson ANA, Koval KJ, McKee MD, Cantu RV, Bell JE, et al. Is surgery for displaced, midshaft clavicle fractures in adults cost-effective? Results based on a multicenter randomized, controlled trial. J Orthop Trauma. 2010;24(7):426–33.

    Article  PubMed  Google Scholar 

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Correspondence to Kyle J. Jeray M.D. .

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Koerner, M.R., Jeray, K.J. (2018). Nonoperative Clavicle Fractures. In: Groh, G. (eds) Clavicle Injuries. Springer, Cham. https://doi.org/10.1007/978-3-319-52238-8_6

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  • DOI: https://doi.org/10.1007/978-3-319-52238-8_6

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