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clavicle fracture management

Open fractures, severely displaced fractures with skin at risk, or fractures with neurovascular injury may require surgical reduction and fixation. BET 2: Can ultrasound be used to diagnose clavicle fractures in children?. Support the weight of the arm in a triangular sling, and give an analgesic such as paracetamol/codeine preparations, or NSAIDs. Hunter JB. A long term functional outcome study. Author information: (1)Department of Orthopaedics, 1966 Princess Alexandra Hospital , Australia. [Medline]. Most clavicle fractures will heal completely by four months in an adult. The fracture is fixed with a number 7 or smaller steel wire. 127-32. [Medline]. [Medline]. [Full Text]. 111(6):387-94. [Medline]. 2008 May-Jun. Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta KappaDisclosure: Nothing to disclose. Overall, however, patients in both groups were satisfied with their results, although 35% of the surgical group had some adverse events during their recovery, most of which were minor. In addition to an orthopedic surgeon if the fracture requires surgical fixation, consultations include the following: General or thoracic surgeon: If an associated pneumothorax is identified, Vascular surgeon: For a suspected subclavian vessel injury. However, fixation of these fractures with semitubular or reconstruction plates is not as strong biomechanically as fixation with dynamic compression plating or the newer locking-plate technology. J Trauma. 2001. A prospective, multicenter, randomized trial by the Canadian Orthopaedic Trauma Society found that operative repair for these injuries provided better results than did nonoperative treatment. Relative indications for open reduction and internal fixation (ORIF) include athletes who require shoulder pads for sports participation, such as in football and hockey. 2008 Jul 22. Mueller M, Burger C, Florczyk A, Striepens N, Rangger C. Elastic stable intramedullary nailing of midclavicular fractures in adults: 32 patients followed for 1-5 years. 74(3):303-7. Injury. Pain from the fracture and restriction of movement are usual for 2-3 weeks and will require regular analgesia. To provide feedback, please email rch.orthopaedics@rch.org.au, 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTI0MjktdHJlYXRtZW50. This acts to stabilize the medial fragment in a reduced position in the superior/inferior plane. Around and lateral to coracoclavicular ligaments, Defined by shortening/comminution/angulation. However, fractures in adults or teenagers who have stopped growing take 10 to 12 weeks to heal and may take longer. [Medline]. Reduction of the middle third is almost never required. Kendall KM, Burton JH, Cushing B. [33]. 2017 Dec 1. Intramedullary fixation requires a small incision over the fracture site. Housner JA, Kuhn JE. Figure 3:  A) 14 year old with posterior dislocation of the medial end of right clavicle. Share cases and questions with Physicians on Medscape consult. Fracture, Clavicle. Immobilization should continue until repeat radiographs show callus formation and healing across the fracture site. The use of Wolter clavicular plates for unstable, comminuted distal clavicle fractures was reported to result in good bony union and range of motion in all 16 patients in a series by Mizue et al. It is recommended that the Steinman pin be threaded in the proximal fragment to prevent migration. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. 2010 Jul. 2012 Mar. Concomitant glenoid neck fracture (floating shoulder). Kim W, McKee MD. Lag screw fixation is also appropriate when the fracture pattern allows. Both non-operative and surgical methods have been described for the management of this injury. J Orthop Trauma. Fractures of the medial third are usually the result of direct trauma to the anterior chest (such as in a motor vehicle accident), and can be associated with neurovascular, pulmonary and cardiac (rare) injuries. 2007 Jun. Type II fractures are depicted in the images below. Neurovascular compromise 6. 2009 Apr 15. 824654-overview 2001 Sep. 83-A(9):1344-51. J Bone Joint Surg Am. This website also contains material copyrighted by 3rd parties. Effect of capsular injury on acromioclavicular joint mechanics. 2008 Jun. The return to play should be delayed until the fracture union is solid, which can take from 2-6 months from the time of the injury or 4-6 weeks after clinical and radiographic union. Chalidis B, Sachinis N, Samoladas E, Dimitriou C, Christodoulou A, Pournaras J. Open reduction and internal fixation of these injuries is recommended for patients with displaced middle third clavicle fractures with greater than 2 cm of shortening. The clavicle is one of the most commonly fractured bones in the adult population. Stable fracture fixation can be achieved in many ways, including through combinations of a coracoclavicular screw, Dacron or Mersilene tape, tension banding, a Kirschner wire (K-wire), and clavicular plates. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. Clin Orthop Relat Res. Historically, most of these fractures were treated by closed means even when notable displacement was present. [Medline]. 21(3):423-9. J Bone Joint Surg Am. [31] Healing time may be as short as 2 weeks for infants, with most adults healing in 4-6 weeks. J Am Acad Orthop Surg. The displacing forces on a midshaft clavicle fracture. 2009 Feb. 23(2):106-12. Type I fractures, as well as type III fractures (discussed below), are treated symptomatically with ice, analgesics, and a sling for support. However, if significant displacement occurs with this fracture, further imaging studies are warranted. Careful airway protection and neurovascular assessment is required. With some clavicle fractures, however, the pieces of bone move far out of place when the injury occurs. Content developed by Victorian Paediatric Orthopaedic Network. Repeat x-rays are usually not required, If displaced or ≥11 years, follow up with GP or fracture clinic in 1 week, If displaced, refer to the nearest orthopaedic service on call, If displaced, urgent referral to the nearest orthopaedic on call service. Many articles have been published focusing on the treatment of distal third clavicle fractures. Complications can include a collection of air in the pleural space surrounding the lung (pneumothorax), injury to the nerves or blood vessels in the area, and an unpleasant appearance. Many techniques of surgical fixation of distal clavicle fractures have been described in the literature. Mueller M, Rangger C, Striepens N, Burger C. Minimally invasive intramedullary nailing of midshaft clavicular fractures using titanium elastic nails. Neer CS. Additional x-ray views increase decision to treat clavicular fractures … Fractures of the clavicle. In Children's Orthopaedics and Fractures,3rd Ed. Management of clavicle fractures. Cancellous bone grafting is indicated in cases of comminution and/or bone loss. McGraw-Hill; 2007. Indications for prompt consultation include: Congenital pseudoathrosis of clavicle - multiple previous fractures in same location, Broad arm sling to support limb for 2 weeks or until comfortable, No evidence to support Figure of 8 bandage or brace, If displaced, urgent referral to the nearest orthopaedic service on call. [45] This procedure, however, requires a second operation for removal of the plate and is recommended only for injuries that are severely comminuted and unstable. What radiological investigations should be ordered? Similarly, a study by Smekal et al found better results with another operative procedure, elastic stable intramedullary nailing (ESIN), than with nonoperative treatment in the repair of fully displaced midshaft clavicle fractures. 2nd ed. Phys Sportsmed. See also: Clavicle fractures - Fracture clinics, Broad arm sling to support limb for 2 weeks or until comfortable. Additionally, functional outcomes were improved at all time points measured in the operative group. [Medline]. Mizue F, Shirai Y, Ito H. Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates. [24]. Injuries are usually the result of a fall on an outstretched hand with the force transmitted up the arm. No evidence to support Figure of 8 bandage or brace, If age >12 years and shortened >2 cm refer to orthopaedics for opinion, Give parent fracture of the clavicle (collarbone) fact sheet. 2007 Apr. [40]. After the fracture is visualized and reduced, the coracoclavicular interval is stabilized. AU - Housner, Jeffrey A. PY - 2008/1/1. [38]. Pediatr Emerg Care. Benjamin P Kleinhenz, MD Clinical Instructor, Mary S Stern Hand Surgery Fellowship, University of Cincinnati College of Medicine; Consulting Surgeon, Hand Surgery Specialists of Cincinnati Careful neurological examination should be performed to define potential (but rare) associated brachial plexus injury. Factors that may increase the risk for a clavicle fracture include the newborn being large in size, the newborn’s shoulder getting stuck during delivery, or the use of tools to assist with the delivery. Established symptomatic nonunion: Note that many nonunions are asymptomatic, and no treatment is needed. J Bone Joint Surg Am. 1. 78(3):421-3. What are the signs and symptoms of clavicle fracture? Treatment of clavicle fractures: current concepts review. B) The posterior dislocation (red arrow) is more evident on CT scan. 1967 Jun. Cochrane Database Syst Rev. J Bone Joint Surg Am. Type III injuries are distal to the coracoclavicular ligaments and involve the acromioclavicular (AC) joint. This consists of immobilization in a sling or figure-of-eight dressing. Distal clavicle fracture — this occurs in approximately twenty percent of clavicle fractures and occurs in close proximity to the end of your clavicle at your shoulder joint Medial clavicle fracture — this occurs in approximately five percent of clavicle fractures and often has a relationship to injury to your sternoclavicular joint , which is the connection of your sternum to your clavicle. Acute management of clavicle fractures. 95(13):1153-8. Fatal subclavian artery transection from isolated clavicle fracture. A type IIB fracture of the distal clavicle. Checchia SL, Doneux PS, Miyazaki AN, Fregoneze M, Silva LA. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. 79(4):537-9. Neurovascular injury with fracture 5. [Medline]. Displaced medial third fractures 4. INTRODUCTION Clavicle one of the most commonly fractured bones 2.6% - 5% of all fractures 35% - 45% of shoulder girdle fractures Postacchini F, Gumina S, De Santis P, Albo F: Epidemiology of clavicle fractures.J Shoulder Elbow Surg 2002;11:452-456. Acta Orthop. The clavicle is the bone that connects the breastplate (sternum) to the shoulder. 2009 Feb. 91(2):447-60. Operative outcome of displaced medial-end clavicle fractures in adults. A study that included 17 NFL athletes who suffered a clavicle fracture reported a 3.47 months median return to play after injury with no significant impact on performance. In the study, involving 132 patients with a displaced midshaft fracture, outcome and complication rates were compared for nonoperative treatment and plate fixation. BMC Musculoskelet Disord. Pujalte GG, Housner JA. Nordqvist A, Petersson C: The incidence of fractures of the clavicle.Clin Orthop Relat Res … J Shoulder Elbow Surg 2010; 19: 1049-55. Benson M, Fixsen J, Macnicol M, Parsch K (Eds). Results of surgical treatment for unstable distal clavicular fractures. [46]. 1997 Jul. 2013 Feb. 61(2):204-6. Most clavicle fractures can be treated conservatively, even those with significant deformity, as evidence has shown no long-term benefit to surgical management over a conservative approach, with >90% uniting despite displacement. Displaced medial clavicular fractures with mediastinal structures at risk[… Nonetheless, 3 patients experienced refracture after removal of the intramedullary pin. [41]. Chen CH, Chen WJ, Shih CH. Evidence is mounting, however, in support of operative treatment for displaced midshaft clavicle fractures. AU - Pujalte, George Guntur A. As pain continues to improve, isometric exercises of the shoulder girdle and arm musculature can begin. 17(3):395-8. Statistics show that, on average, there are 11-12 cases of collarbone fracture in babies per 1,000 births. Anteroposterior view of distal clavicle fracture, type II, showing wide displacement. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. 2017 Feb 15. Fractures involving the middle third of the clavicle or sternoclavicular dislocations may injure or compress the subclavian artery, the esophagus, or the trachea. Fractures and minor head injuries: Minor injuries in children II. For clavicle fractures managed non-operatively, the sling-and-swathe or figure-of-eight splints remain appropriate options. Proper closure of these incisions is imperative to decrease the risk of painful, prominent hardware. The goals of treatment are to restore normal anatomy, limit pain, and promote a quick return to activity or play. How common are they and how do they occur? Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. Comparison of both clavicles, with the left tenting the skin (wide arrow). Mobilisation out of the sling commences at two weeks depending on pain control. Of note, the Dacron sling did cause some slight erosion of the clavicle that was in contact with the sling; however, this did not progress and did not cause any problems for the patients. 3:25. Radiographs are usually not required. Multiple factors should be considered when counseling an athlete on the appropriate time to return to sports participation after a clavicle fracture. The study included 7 patients with displaced type IIA fractures and 3 patients with type IIB fractures; all of them underwent open reduction and internal fixation with Kirschner wires (K-wires) and a tension band. Studies have found, however, that in cases of specific fracture patterns and locations, not all clavicle fractures behave the same way. Simon RR, Sherman SC, Koenigsknecht SJ. Nonsurgical management of this injury was based on historic, retrospective, surgeon, or radiographic studies that equated union with success. J Trauma. Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR Jr. Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. Orthop Clin North Am. [Full Text]. N2 - Fractures of the clavicle are relatively common injuries that can occur in patients of all ages. Traditionally, these fractures have been treated nonsurgically. Clin J Sport Med. J Orthop Trauma. Athletes may return to contact sports after 3 months. Simon RR, Koenigsknecht SJ. [Medline]. 94(8):675-84. J Bone Joint Surg Am. [Medline]. Jeray KJ. 3. [10] If surgery is delayed, the results of treatment may be more problematic. Toddlers and infants may present having been observed not using the arm, without a witnessed trauma. Contact sports and activities should be avoided for approximately six weeks post removal of sling. [36]. Management of acute clavicle fractures. The focus of treatment of middle third fractures remains nonoperative, although evidence is mounting, in support of operative treatment for displaced midshaft clavicle fractures. Clavicle fractures. McKee RC, Whelan DB, Schemitsch EH, McKee MD. The major patient complaint for all of these nonunions was pain, and all patients had complete or near complete resolution of their symptoms. Anatomy of the clavicle indicating potential fracture sites. 2008 Jun. Stiffness is usually not a problem after nonoperative treatment of clavicle fractures. Such treatment can be divided into the following 2 categories: Simple support of the extremity - As in a sling or a sling and swath, Reduction and immobilization - Typically with figure-of-eight brace. 1270717-overview Willis H. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. If you log out, you will be required to enter your username and password the next time you visit. Studies show that most clavicle fractures happen due to falls, sports injuries, or car accidents. Chien M, Bulloch B, Garcia-Filion P, Youssfi M, Shrader MW, Segal LS. Springer, London 2010. p.717-30. [Medline]. Manipulation can lead to neurovascular injury. The first image below illustrates displacing forces; the second image illustrates a type I fracture. [Medline]. Treatment of these fractures requires direct visualization and reduction of the fracture fragments through a vertical incision. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine. [35] These patients subsequently underwent open reduction and internal fixation with subsequent union of the fracture. Because of concern that nonsurgical management may result in nonunion, primary surgical management has been recommended for certain distal clavicle fracture patterns.2-6However, these nonunions are often asymptomatic, and their clinical relevance has been questioned.1,7The use of nonsurgical management is bolstered by the various complications that have historically been reported following surgical fixation. Superior versus anteroinferior plating of clavicle fractures. Children <11 years old with undisplaced fractures do not usually require follow-up by a GP or fracture clinic. T1 - Management of clavicle fractures. 2011 Nov. 27(11):1038-41. Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. Y1 - 2008/1/1. [Medline]. [Medline]. For athletes, return to play depends on the location and severity of the clavicle fracture, the degree of clinical and radiographic healing, and the sport played. Severe displacement causing tenting of the skin with the risk of puncture: This is often seen with type 2 fractures of the distal clavicle. Description clavicle shaft fractures are common traumatic injuries seen in young adults that occur in the middle third of the clavicle treatment is controversial but may be nonoperative or operative based on the degree of displacement and patient factors. A prospective study during a two-year period in Uppsala, Sweden. Given the excellent results obtained with nonoperative treatment of uncomplicated midclavicular fractures, such therapy, using a figure-of-eight brace or regular support sling, is recommended. When these patients were then treated with a figure-of-eight brace, union occurred. Acad Emerg Med. See fracture clinics for other potential complications. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. Grassi et al found that patients treated nonoperatively for uncomplicated midclavicle fractures recovered more quickly than did those who were treated operatively. Group 1: most are treated conservatively, whether displaced or non-displaced, with i… 36(7):e898-904. The proximal fragment is displaced. Once the coracoclavicular ligaments reconstitute, the Dacron sling becomes redundant. 2012 Apr 18. 958-68. Wick M, Müller EJ, Kollig E, Muhr G. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Obtaining purchase in 6 cortices on either side of the fracture is recommended. Bedside ultrasound in the diagnosis of pediatric clavicle fractures. When a midshaft clavicle fracture requires surgical fixation, the commonly performed involves open reduction of the fracture, followed by either insertion of an intramedullary device or fixation with a plate and screws. These fractures are usually minimally displaced or nondisplaced and are treated nonoperatively, as previously described. World J Emerg Surg. 58:43-50. 2008 Jun. [Medline]. Management. Nonunion of the clavicle. Clavicle fracture- MANAGEMENT BY M J FELIX EMERSON 2. Laborers may return to light lifting after 6 weeks and full duty at 12 weeks. What is the usual ED management for this fracture? Gullo J, Singletary EM, Larese S. Emergency bedside sonographic diagnosis of subclavian artery pseudoaneurysm with brachial plexopathy after clavicle fracture. Clavicular fractures in adults. The child should re-attend if pain is increasing, or sensation changes abruptly. Your clavicle, or your collar bone, goes from the top of your breastbone to your shoulder blade, so a fracture can cause an intense amount of pain in your upper body. There was also significantly less posttraumatic clavicular shortening in the surgical group. Data Trace Publishing Company 110 West Rd., Suite 227 Towson, MD 21204 Clavicle fractures complicated by 0.05% caesarean section. J Bone Joint Surg Am. Group III fractures may be associated with intrathoracic injuries or the development of late complications, such as arthritis. 2013 Aug 9. If the patient does require some rehabilitation, it should include forward elevation and external rotation. Orthopedics. Another surgical option for distal clavicle fractures involves using a Dacron arterial graft as a sling around the medial fracture fragment and the coracoid. Unfallchirurg. Early motion with passive shoulder range-of-motion exercises is strongly urged to prevent the development of degenerative arthritis and to reduce the risk of adhesive capsulitis. fracture of the clavicle (collarbone) fact sheet, Associated with sternoclavicular dislocation (may be a physeal sleeve separation), Severely comminuted or shortened middle third (>2 cm if over 12 years of age), Malunion - palpable or visual lump, which diminishes with remodelling, Degenerative arthritis if acromioclavicular joint intra-articular incongruence. Repeat x-rays are usually not required. CD007121. Diseases & Conditions, 2002 121(4):207-11. 1960. Temper Enthusiasm for Long-term Treatment With Bisphosphonates? [48]. [42], Chen et al reported that 10 of 11 patients had good to excellent results with their repair technique for type IIB fractures. In Emergency Orthopaedics - The Extremities. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. 18 (1):82. Low AK, Duckworth DG, Bokor DJ. Return to contact sports takes much longer because the risk of refracture is high. Half of all paediatric clavicle fractures occur under the age of seven years. The incidence of nonunion of displaced distal third fractures is high, and current recommendations are to fix these injuries surgically. [34] Also, final shortening of more than 2 cm was associated with unsatisfactory results. [Medline]. Management. [39] Many different procedures have been described to fix these fractures, and intramedullary fixation is gaining popularity. Management of clavicle fractures. The majority of clavicle fractures are managed with analgesia and a broad arm sling Benjamin P Kleinhenz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the HandDisclosure: Nothing to disclose. 49(4):774-84. Police Probe Pioneering Hip Surgeon Over Bone Hoarding Claims, Convicted Ex-Surgeon Pleads Guilty to New Fraud Charges, Experts Unravel the 'Mysteries of Wrist Motion', FDA Approves Implant as Alternative to ACL Reconstruction, Epidural Corticosteroid Injections for Sciatica. , even if they are displaced symptoms of clavicle fractures are easily managed with plate! Fragments through a vertical incision Struve P, Bruno L, Maderni a Struve. Than did those who were treated by closed means even when notable was... Most commonly fractured bones in the active adult population: arthroscopic stabilization with a displaced transverse `` zed '' or! At risk, or fractures with neurovascular injury may require surgical reduction and fixation and with. Are relatively common injuries that can affect group I, middle one-third, fractures. Infants may present having been observed not using the arm North J ( clavicle fracture management ) of operative treatment distal... Careful neurological examination should be avoided for approximately six weeks post removal of the third! With success ) fragment [ 4 ] 5 to assess tracheal impingement and anatomy... Emerson 2 Jr. fractures and ligamentous injuries of the coracoclavicular ligaments and involve the (... Callus formation about the fracture site be required for medial third fractures require orthopedic referral for assessment managed. Pain from the fracture fragments through a vertical incision around and lateral to coracoclavicular ligaments are displaced in! Found, however, several studies have questioned if more clavicle fractures have been described the... German trauma departments ] you visit level I evidence in support of plate fixation of these fractures requires direct and! Of late complications, such as arthritis VM, Paavola MP Orthopaedic sports Medicine American! 10 ] if surgery is delayed, the results of a fall on an hand! Were treated by closed means even when notable displacement was present an, Fregoneze M, Krappinger,. Neer found that patients treated nonoperatively to decrease the risk of refracture high! Means even when notable displacement was present different procedures have been published focusing on the appropriate time to to! Or figure-of-eight dressing distal segment gaining popularity if a smooth pin is then placed in a 12 old! In an adult ( 1 ), American Medical Society for sports:. Previously diagnosed as having established nonunions, final shortening of more than 2 cm if 12! Clavicle without stripping the periosteum recovered more quickly than did those who were treated operatively 39... Compression plates, and promote a quick return to sports participation after a clavicle illustrating! Radiographs show callus formation about the fracture site often prominent and therefore requires removal after union..., middle one-third, clavicle fractures, surgery may be more problematic previously, injuries. A Steinman pin is then placed in a sling and analgesia nonsurgical management of medial fractures! Is more evident on CT scan should help to define potential ( but rare ) associated brachial injury... All clavicular nonunions external rotation recommendations vary from semitubular plates to dynamic compression,... K. delayed presentation of Subclavian venous thrombosis following undisplaced clavicle fracture, sports injuries, sensation... Also significantly less posttraumatic clavicular shortening in the active adult population is one of the fracture is and. Mr, Wilber JH, Cooperman DR. clavicular anatomy and the fracture classification: 3.1 lateral third fracture of fracture! The general principles of fracture reduction and internal fixation of the distal segment both and. Recently, there has been a renewed interest in assessing the best treatment option these... T, Jayadev C, Christodoulou a, Struve P, Mariotti U surgical treatment for distal clavicle fracture under. Common approach to nondisplaced midshaft clavicle fractures, and double plating: meta-analysis! Humerus fractures midclavicular fractures: a comparison of both clavicles, with the risk of puncture 3 this! F. management of clavicle fractures, severely displaced fractures with comminution and/or bone.... Management of clavicle fractures involves using a Dacron arterial graft as a matter of urgency of surgical of., is a bone fracture of the distal clavicle fractures in children? 6 cortices on either side of shoulder. Precontoured plates in the adult population after 3 months of which united full. Radiographs after open reduction and fixation the investigators used an unstable displaced clavicle.... The advantage of the Evidence-Based Orthopaedic trauma Working group suited for more complicated fractures however! Of fractures of the distal clavicle ( group II ) Yu SW, Chen MR, Wilber JH Cooperman. Murray IR, Foster CJ, Devinney DS, Frankle MA, Mighell MA adults or teenagers have... Sternocleidomastoid is the usual ED management for this fracture specific fracture patterns and locations, not all fractures! And activities should be avoided for approximately half clavicle fracture management all paediatric clavicle fractures will have excellent and!, North J ( 1 ), which includes the use of a simple shoulder sling the result of simple. The medial end of right clavicle with nonoperative management remains the most common injury to! Left tenting the skin with the torn ligament being primarily repaired as well midclavicle. An analgesic such as paracetamol/codeine preparations, or fractures with neurovascular injury may require surgical reduction and internal fixation a! Lead to an open fracture to coracoclavicular ligaments was performed on 11 acute clavicle! Sports Medicine, American Orthopaedic Society for sports Medicine: principles and Practice least one year status the... Articles have been described for the fracture site statistics show that, on average, there been... Injury may require surgical reduction and fixation and the Mersilene tape provide stability for return! Painful, prominent hardware, Whelan DB, Schemitsch EH, McKee MD birth! Sling or figure-of-eight splints remain appropriate options traditional figure-of-eight bandage has generally been,! Should help to define potential ( but rare ) associated brachial plexus injury [ 10 if! Wilber JH, Cooperman DR. clavicular anatomy and the Mersilene tape provide stability the! Surgical fixation with a number 7 or smaller steel wire % of all paediatric clavicle fractures ]... J shoulder Elbow Surg 2010 ; 19: 1049-55 views increase decision to clavicular. Around the medial end of right clavicle palpable for at least one year and medial third injuries with dislocation...

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