Skip to main content
SpringerLink
Log in

Laterale Klavikulafraktur

Klassifikationen und Therapieoptionen

Distal clavicle fractures

Classifications and management

  • Leitthema
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Zehn bis 30 % der Klavikulafrakturen betreffen das laterale Drittel. Die laterale Klavikulafraktur ist als Verletzung der akromiokorakoklavikulären Region in vielen Fällen eine Kombination aus Fraktur und ligamentärer Verletzung. Für die Wahl des optimalen Therapieverfahrens ist daher die Bewertung der Stabilität von entscheidender Bedeutung.

Ziel

Ziel dieser Arbeit ist es, eine Übersicht über die bestehenden Klassifikationssysteme zu geben und die einzelnen Frakturtypen unter Berücksichtigung anatomisch-funktioneller Aspekte bzgl. Stabilität und Instabilität zu ordnen. Weiterhin werden die etablierten Operationsverfahren mit ihren typischen Vor- und Nachteilen dargestellt, um frakturtypspezifisch geeignete Operationsverfahren zu ermitteln.

Ergebnisse und Diskussion

Stabile Frakturen heilen unter konservativer Behandlung meist problemlos aus, instabile Frakturen haben ein höheres Risiko, in einer symptomatischen Pseudarthrose zu enden. Instabile Frakturen sollten daher bei hohem funktionellem Anspruch des Patienten operativ therapiert werden. Die operative Behandlung instabiler Frakturen führt mit winkelstabiler Plattenosteosynthese und zusätzlicher korakoklavikulärer(CC)-Fixierung zu guten klinischen Ergebnissen. Die arthroskopisch unterstützte CC-Fixierung bietet neben der Behandlung von Begleitpathologien den Vorteil der Minimal-Invasivität.

Abstract

Background

Fractures of the distal third of the clavicle represent 10–30 % of all clavicle fractures . Frequently, these fractures result in instability due to a combination of bony and ligamentous injury. Thus, assessment of the stability is essential for adequate treatment of these fractures.

Aim

This article presents a review of the different classification systems for distal clavicle fractures with respect to anatomical and functional factors to allow for comprehensive assessment of stability. Furthermore, the different treatment options for each fracture type are analyzed.

Results and discussion

Fractures to the distal third of the clavicle without instability can be treated conservatively with satisfactory outcome. In contrast, instability may result in symptomatic non-union under conservative treatment; therefore, distal clavicle fractures with instability should be treated operatively with respect to the functional demands of the patient. Operative treatment with locked plating in combination with coracoclavicular fixation results in excellent functional results. Arthroscopically assisted fracture fixation may be beneficial in terms of a minimally invasive approach as well as assessment and treatment of associated glenohumeral lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Allman FL Jr (1967) Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am 49:774–784

    PubMed  Google Scholar 

  2. Andersen K, Jensen PO, Lauritzen J (1987) Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling. Acta Orthop Scand 58:71–74

  3. Arrigoni P, Brady PC, Zottarelli L et al (2014) Associated lesions requiring additional surgical treatment in grade 3 acromioclavicular joint dislocations. Arthroscopy 30:6–10

    Article  PubMed  Google Scholar 

  4. Ballmer FT, Gerber C (1991) Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases. J Bone Joint Surg Br 73:291–294

    CAS  PubMed  Google Scholar 

  5. Banerjee R, Waterman B, Padalecki J et al (2011) Management of distal clavicle fractures. J Am Acad Orthop Surg 19:392–401

    PubMed  Google Scholar 

  6. Barbier O, Malghem J, Delaere O et al (1997) Injury to the brachial plexus by a fragment of bone after fracture of the clavicle. J Bone Joint Surg Br 79:534–536

    Article  CAS  PubMed  Google Scholar 

  7. Bosworth BM (1941) Acromioclavicular Seperation. A new method of repair. Surg Gynecol Obstet 73:866–871

    Google Scholar 

  8. Brunner U, Habermeyer P, Schweiberer L (1992) Special status of lateral clavicular fracture. Orthopade 21:163–171

    CAS  PubMed  Google Scholar 

  9. Chen CE, Liu HC (2000) Delayed brachial plexus neurapraxia complicating malunion of the clavicle. Am J Orthop (Belle Mead NJ) 29:321–322

    CAS  Google Scholar 

  10. Chiang CL, Yang SW, Tsai MY et al (2010) Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoulder Elbow Surg 19:e13–e15

    Article  PubMed  Google Scholar 

  11. Craig EV (2006) Fractures of the clavicle. In: Rockwood CA, Green DP (Hrsg) Fractures in adults, 6. Aufl., Bd 1. Lippncott Willians & Wilkins, Philadelphia, S 1216–1217

  12. Eskola A, Vainionpaa S, Patiala H et al (1987) Outcome of operative treatment in fresh lateral clavicular fracture. Ann Chir Gynaecol 76:167–169

    CAS  PubMed  Google Scholar 

  13. Flinkkila T, Ristiniemi J, Lakovaara M et al (2006) Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta Orthop 77:644–649

    Article  PubMed  Google Scholar 

  14. Goss TP (1993) Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma 7:99–106

    Article  CAS  PubMed  Google Scholar 

  15. Hohmann E, Hansen T, Tetsworth K (2012) Treatment of Neer type II fractures of the lateral clavicle using distal radius locking plates combined with TightRope augmentation of the coraco-clavicular ligaments. Arch Orthop Trauma Surg 132:1415–1421

    Article  PubMed  Google Scholar 

  16. Jäger M, Breitner S (1984) Therapiebezogene Klassifikation der lateralen Claviculafraktur. Unfallheilkunde 87:467–473

    PubMed  Google Scholar 

  17. Jain S, Altman GT (2011) Lateral clavicle fractures. J Hand Surg Am 36:1213–1215

    Article  PubMed  Google Scholar 

  18. Jensen KL, Rockwood CA (2009) Radiographic Evaluation of Shoulder Problems. Saunders Elsevier, Philadelphia

    Book  Google Scholar 

  19. Kalamaras M, Cutbush K, Robinson M (2008) A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique. J Shoulder Elbow Surg 17:60–62

    Article  PubMed  Google Scholar 

  20. Khan LA, Bradnock TJ, Scott C et al (2009) Fractures of the clavicle. J Bone Joint Surg Am 91:447–460

    Article  PubMed  Google Scholar 

  21. Kona J, Bosse MJ, Staeheli JW et al (1990) Type II distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma 4:115–120

    Article  CAS  PubMed  Google Scholar 

  22. Lambert SM, Hertel R, Ballmer FT (2001) Clavicle fractures. In: Wülker N, Mansat M, Fu FH (Hrsg) Shoulder surgery: an illustrated textbook. Martin Dunitz, London, S 487–501

  23. Latarjet M, Michoulier J, Kohler R (1975) Fracture of the clavicle with avulsion of the coracoid plaque. Apropos of 2 cases. Chirurgie 101:245–249

    CAS  PubMed  Google Scholar 

  24. Levy O (2003) Simple, minimally invasive surgical technique for treatment of type 2 fractures of the distal clavicle. J Shoulder Elbow Surg 12:24–28

    Article  PubMed  Google Scholar 

  25. Loriaut P, Moreau PE, Dallaudiere B et al (2013) Outcome of arthroscopic treatment for displaced lateral clavicle fractures using a double button device. Knee Surg Sports Traumatol Arthrosc

  26. Lyons FA, Rockwood CA Jr (1990) Migration of pins used in operations on the shoulder. J Bone Joint Surg Am 72:1262–1267

    CAS  PubMed  Google Scholar 

  27. Macheras G, Kateros KT, Savvidou OD et al (2005) Coracoclavicular screw fixation for unstable distal clavicle fractures. Orthopedics 28:693–696

    PubMed  Google Scholar 

  28. Madsen W, Yaseen Z, Lafrance R et al (2013) Addition of a suture anchor for coracoclavicular fixation to a superior locking plate improves stability of type IIB distal clavicle fractures. Arthroscopy 29:998–1004

    Article  PubMed  Google Scholar 

  29. Martetschlager F, Gaskill TR, Millett PJ (2013) Management of clavicle nonunion and malunion. J Shoulder Elbow Surg 22:862–868

    Article  PubMed  Google Scholar 

  30. Martetschlager F, Kraus TM, Schiele CS et al (2013) Treatment for unstable distal clavicle fractures (Neer 2) with locking T-plate and additional PDS cerclage. Knee Surg Sports Traumatol Arthrosc 21:1189–1194

    Article  PubMed  Google Scholar 

  31. Motta P, Bruno L, Maderni A et al (2014) Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope. J Shoulder Elbow Surg 23:e47–e52

    Article  PubMed  Google Scholar 

  32. Nadarajah R, Mahaluxmivala J, Amin A et al (2005) Clavicular hook-plate: complications of retaining the implant. Injury 36:681–683

    Article  CAS  PubMed  Google Scholar 

  33. Neer CS 2nd (1960) Nonunion of the clavicle. J Am Med Assoc 172:1006–1011

    Article  PubMed  Google Scholar 

  34. Neer CS 2nd (1963) Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma 3:99–110

    Article  PubMed  Google Scholar 

  35. Neer CS 2nd (1968) Fractures of the distal third of the clavicle. Clin Orthop Relat Res 58:43–50

    PubMed  Google Scholar 

  36. Neviaser JS (1963) The Treatment of fractures of the Clavicle. Surg Clin North Am 43:1555–1563

    CAS  PubMed  Google Scholar 

  37. Nordqvist A, Petersson C, Redlund-Johnell I (1993) The natural course of lateral clavicle fracture. 15 (11–21) year follow-up of 110 cases. Acta Orthop Scand 64:87–91

    Article  CAS  PubMed  Google Scholar 

  38. Oh JH, Kim SH, Lee JH et al (2011) Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg 131:525–533

    Article  PubMed  Google Scholar 

  39. Pauly S, Kraus N, Greiner S et al (2012) Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elbow Surg 22(6):760–766

  40. Penn I (1964) The vascular complications of fractures of the clavicle. J Trauma 4:819–831

    Article  CAS  PubMed  Google Scholar 

  41. Postacchini F, Gumina S, De Santis P et al (2002) Epidemiology of clavicle fractures. J Shoulder Elbow Surg 11:452–456

    Article  PubMed  Google Scholar 

  42. Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80:476–484

    Article  CAS  PubMed  Google Scholar 

  43. Robinson CM, Cairns DA (2004) Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg Am 86-A:778–782

    PubMed  Google Scholar 

  44. Robinson CM, Court-Brown CM, Mcqueen MM et al (2004) Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 86-A:1359–1365

    PubMed  Google Scholar 

  45. Robinson CM, Akhtar MA, Jenkins PJ et al (2010) Open reduction and endobutton fixation of displaced fractures of the lateral end of the clavicle in younger patients. J Bone Joint Surg Br 92:811–816

    Article  CAS  PubMed  Google Scholar 

  46. Rokito AS, Zuckerman JD, Shaari JM et al (2002) A comparison of nonoperative and operative treatment of type II distal clavicle fractures. Bull Hosp Jt Dis 61:32–39

    PubMed  Google Scholar 

  47. Seppel G, Lenich A, Imhoff AB (2014) Distal clavicle fracture. Oper Orthop Traumatol 26:254–262

    Article  CAS  PubMed  Google Scholar 

  48. Soliman O, Koptan W, Zarad A (2013) Under-coracoid-around-clavicle (UCAC) loop in type II distal clavicle fractures. Bone Joint J 95-B:983–987

    Article  CAS  PubMed  Google Scholar 

  49. Stanley D, Trowbridge EA, Norris SH (1988) The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br 70:461–464

    CAS  PubMed  Google Scholar 

  50. Stegeman SA, Nacak H, Huvenaars KH et al (2013) Surgical treatment of Neer type-II fractures of the distal clavicle: a meta-analysis. Acta Orthop 84:184–190

    Article  PubMed Central  PubMed  Google Scholar 

  51. Tiren D, Van Bemmel AJ, Swank DJ et al (2012) Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview. J Orthop Surg Res 7:2

    Article  PubMed Central  PubMed  Google Scholar 

  52. Tischer T, Salzmann GM, El-Azab H et al (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37:136–139

    Article  PubMed  Google Scholar 

  53. Zanca P (1971) Shoulder pain: involvement of the acromioclavicular joint. (Analysis of 1,000 cases). Am J Roentgenol Radium Ther Nucl Med 112:493–506

    Article  CAS  PubMed  Google Scholar 

Download references

Danksagung

Die Autoren danken Herrn Igor Zovic für die Darstellung der Frakturtypen.

Author information

Authors and Affiliations

  1. Schulter- und Ellenbogenchirurgie, Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Klinikum der Universität München (LMU), München, Deutschland

    Ben Ockert & F. Haasters

  2. OCM Klinik, München, Deutschland

    E. Wiedemann

Authors
  1. Ben Ockert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Wiedemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Haasters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ben Ockert.

Ethics declarations

Interessenkonflikt

B. Ockert, E. Wiedemann und F. Haasters geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag enthält keine Studien an Menschen oder Tieren.

Additional information

Redaktion

F. Haasters, München

B. Ockert, München

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ockert, B., Wiedemann, E. & Haasters, F. Laterale Klavikulafraktur. Unfallchirurg 118, 397–406 (2015). https://doi.org/10.1007/s00113-015-0003-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-015-0003-1

Schlüsselwörter

Keywords

Search

Navigation