Fractures of clavicle

• frequent fractures arising usually indirectly from a fall on the shoulder (sports injuries)
• it most often breaks in the middle third
• typical dislocation of the medial fragment upwards (pulling of the sternocleidomastoid muscle), and further approximation of both fragments by pulling of pectoralis minor muscle

Classification (according to frequency of disability) - according to Allman

• Typ 1 – middle third fractures
• Typ 2 – lateral third fractures
• Typ 3 – fractures of the medial third

clavicle fracture

Clinical signs

• pain limiting movement in the shoulder joint
• drooping shoulder
• antalgic holding HK
• visible dislocation
• palpable crepitation and pathological mobility
• hematoma (in older fractures due to gravity it descends to the breast area)
• may be an open fracture (often a small perforation of the skin by a fragment)

complication

• brachial plexus injury (examine peripheral innervation)
• vascular injury (a. subclavian – examine the pulse on the a. radialis, v. subclavian – signs of venostasis)

Diagnostics

• X-ray in anteroposterior projection, event. an oblique image from the bottom up, which better informs about the extent of the dislocation

therapy

Conservative (predominant)

• retracting the shoulder dorsally and caudally, permanent pull back with a figure-of-eight bandage or Delbet rings
• Desault's bandage: extension fixation of the upper extremity of the palm to the stomach area with padding under the arm
• after fixation control X-ray
• immobilization for 4 weeks (children 2-3 weeks)
• healing may be accompanied by a more prominent muscle due to relative restlessness during healing (cosmetic problem - diminishes over time)

Operative (mainly for type 2 fractures – lateral end of the clavicle)

• percutaneously introduced K wire (can be supplemented with a loop in traction cerclage) - long oblique fractures
• cannulated cancellous screw – transverse or short oblique fractures
• splint adapted to the shape of the root - reoperation, treatment

links

related articles

• Clavicle
• bones of the upper limb

source

• PASTOR, Jan. Langenbeck’ s medical web page [online]. [cit. 2010]. <http://langenbeck.webs.com>.