Clavicle Shaft Fractures

Abstract

Clavicle fractures are common injuries, representing approximately 3% to 5% of all fractures and 35% to 44% of all shoulder girdle fractures. Most are midshaft fractures resulting from a blow to the lateral aspect of the shoulder or a fall onto the lateral shoulder. Clavicle fractures typically produce a painful deformity. The scapula appears slightly internally rotated and the shoulder appears shortened relative to the opposite side. Radiographs in two projections (standard AP view and 45° cephalic tilt view) are necessary to evaluate the fracture pattern, presence of comminution, displacement, and shortening or distraction of the clavicle fracture. There is a general consensus that nondisplaced and minimally displaced clavicle fractures, and virtually all clavicle fractures in children, are treated nonsurgically with use of a sling or brace. Surgery is indicated for open fractures, fractures associated with neurologic or vascular injury, significantly displaced fractures, closed fractures with greater than 15 to 20 mm of shortening, and comminuted fractures. Good results have been reported with both plate-and-screw fixation and with intramedullary fixation of clavicle shaft fractures.

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