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Clavicle Fracture

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Textbook of Shoulder Surgery

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Abstract

Fractures of the clavicle are common, accounting for 2.6–4% of adult fractures and about a third of injuries to the shoulder girdle. Fractures of the shaft account for between 69% and 82%, lateral-end account for 21–28%, and of the medial-end 2–3% of all clavicle fractures. It is essential to obtain at least 2 radiographic views to determine displacement and/or angulation of a clavicle fracture.

Undisplaced mid-shaft fractures as well as the majority of displaced or angulated fractures are usually managed by conservative means with use of a simple arm sling leading to good outcomes. The degree of shortening or displacement of the fracture is said to be important in the decision making of operative versus non-operative treatment ( shortening or displacement more than 2 cm, is associated with a worse prognosis). Plate fixation or intramedullary devices are widely accepted methods of surgical intervention. Use of an anatomic, pre-contoured compression plate placed on the superior or antero-inferior aspect has gained prominence in recent times as the preferred method of operative treatment for displaced fractures.

Lateral end of the clavicle fractures, if undisplaced are generally treated conservatively and displaced fractures require fixation with either plating techniques or coracoclavicular fixation techniques.

Medial end fractures with anterior displaced fragments are nearly always managed non-operatively. Posteriorly displaced medial end fractures may require surgery with cardiothoracic support.

Most patients with a clavicle fracture can be effectively treated conservatively in a sling for a period of immobilisation to allow initial healing, followed by structured rehabilitation. There is now good evidence that a subset of patients – the young, active, healthy patients with a completely displaced clavicle fracture or over 2 cm overlap – are likely to benefit from primary operative management.

Non-union and malunion are the commonest complications following clavicle fracture treatment. Neurovascular injuries are an uncommon presentation and can be a surgical complication.

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Author information

Authors and Affiliations

  1. Department of Trauma & Orthopaedic Surgery, University Hospital of North Tees & Hartlepool, Hardwick Stockton on Tees, UK

    Rajesh Nanda

  2. Department of Trauma & Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK

    Amar Rangan

  3. University of Oxford, Oxford, UK

    Amar Rangan

  4. University of York, York, UK

    Amar Rangan

Authors
  1. Rajesh Nanda
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  2. Amar Rangan
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Editors and Affiliations

  1. Wrightington Hospital, Wigan, Lancashire, UK

    Ian A. Trail

  2. Wrightington Hospital, Wigan, Lancashire, UK

    Lennard Funk

  3. Orthopaedic Surgery Department, The James Cook University Hospital, Middlesbrough, North Yorkshire, UK

    Amar Rangan

  4. Trauma & Orthopaedics Department, Countess of Chester Hospital, Chester, Cheshire, UK

    Matthew Nixon

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Nanda, R., Rangan, A. (2019). Clavicle Fracture. In: Trail, I., Funk, L., Rangan, A., Nixon, M. (eds) Textbook of Shoulder Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-70099-1_2

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  • DOI: https://doi.org/10.1007/978-3-319-70099-1_2

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