There has been a shift towards surgical management of displaced midshaft clavicle fractures in adults over last decade. The indication for operative treatment of clavicular fractures with bone shortening over 2 cm is much debated. This treatment strategy reportedly achieved high union rate, good functional recovery, and high patientrelated satisfaction. Classical operative treatment indications are open fractures, compromised skin, neurovascular complications or an additional fracture of the. Intramedullary fixation of midshaft clavicle fractures.
Background management of displaced midshaft clavicle fractures is controversial. In 1987 andersen et alreported less discomfort and a trend towards fewer complications with a. Clavicle fracture an overview sciencedirect topics. Clavicle fracture introduction clavicle fractures are a common orthopedic injury, particularly among infants and young children. Conservative management of clavicle fracture clavicle fractures typically result from a direct blow to the shoulder, occurring most frequently to the middle third of the clavicle. Patients with persisting pain or a delayed course under conservative treatment may be candidates for early secondary surgery. Clavicle fracture broken collarbone orthoinfo aaos. Clavicle fractures are among the most common fractures occurring in the general population, and the vast majority are localized in the midshaft portion of the bone. Trauma is the most common cause of a clavicle fracture. Clavicle fracture rehabilitation protocol justin w griffin, md. There seems to be a change towards operative management of displaced midshaft clavicle fracture in skeletally immature patients, driven by published literature in adult clavicle fracture setting. In a single center, prospective clinical trial, 60 patients with displaced midshaft fracture of the clavicle were systematically randomized. Nonoperative treatment of midshaft clavicle fractures in adults.
Nov 01, 2015 surgery and conservative treatment acute clavicle fractures were traditionally treated nonoperatively. Traditional treatment of midshaft clavicle fractures is usually nonoperative management, using a sling or figureofeight. Historically, nonoperative treatment of midshaft clavicular fractures was. However, the challenge is the identification of patients who might benefit from surgical fixation. Clavicle shaft fracture pediatric pediatrics orthobullets. Displaced fractures of the clavicle may be treated nonoperatively in selected cases. Clavicle fractures account for 5% to 15% of childhood fractures, and are the most common type of fracture in children. The intramedullary osteosynthesis of the diaphyseal fracture of the clavicle compared to conservative treatment. The clavicle, also referred to as the collarbone, is a long bone located at the top of the chest. Considering these uncertainties, surgeons are faced with a difficult decision regarding whether operative treatment of a midshaft clavicle fracture will be costeffective. The duration for which the clinical benefits of operative treatment remain superior to those of nonoperative treatment has not been well established in the literature. Plate fixation of middlethird fractures of the clavicle in the semiprofessional athlete. A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder.
Traditional treatment of midshaft clavicle fractures is usually nonoperative management. The majority of clavicle fractures are managed with analgesia and a broad arm sling. A fracture of the clavicle is a relatively common injury that occurs in patients of all ages. Most commonly, these fractures occur within the middle third of the clavicle and exhibit some degree of displacement. Fractures of the middle third, or midshaft, are the most common, accounting for up to 80% of all clavicle fractures. Reported outcomes of surgical treatment of midshaft. The art of femoral fracture care involves a balancing act between anatomic alignment and early functional rehabilitation of the limb. Adolescents who sustained closed mid shaft clavicle fractures between 2000 and 2008 were identified in our institutional trauma registry. Recent evidence, however, reveals that the final result of nonsurgically midshaft clavicular fractures, particularly those with quite large displacements or shortening, is not like that which was previously thought. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. The clavicle is the most commonly fractured long bone in children. They are caused by direct trauma, falls on the shoulder, or falls onto an.
Traditionally midshaft fractures of the clavicle have been treated with immobilization and a sling or figureof8 dressing, and in most cases, results are said to be excellent with low nonunion rates and minimal functional impairment 3. Most common approximately 80% in both adults and children. No evidence to support figure of 8 bandage or brace. Studies of nonoperative treatment of completely displaced, midshaft fractures of the clavicle reveal nonunion rates between 15% and 20% 5,6. An evaluation of treatment options for medial, midshaft. More than 200 methods of operative and nonoperative methods for management of clavicle fractures have been described 6. Clavicle fractures are common in adults and children.
Proximity to vital structures increases the potential risk of catastrophic intraoperative complication. Evidence based management of midshaft clavicle fractures. Aug 20, 2017 clavicle fractures are common, accounting for 2. Clavicle fractures matthew pecci, md, and jeffrey b. Nagda, and the hospital of the university of pennsylvania, philadelphia, pa dr. The majority of clavicle fractures can heal without surgery. Nonoperative treatment compared with plate fixation of. Middle third most common broad arm sling to support limb for 2 weeks or until comfortable. Most clavicle fractures do not require orthopaedic follow up. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle i.
This type of fracture is fairly commonaccounting for about 5 percent of all adult fractures. Management of medial clavicle fractures also has remained nonoperative. The process of decisionmaking on surgical management of medial clavicle fracture can be complicated due to lack of consensus on the indications, and also a potentially challenging nature of surgery. Midshaft clavicle fractures this changed my practice. Medialthird fractures comprise the remaining 2% to 3% of these injuries. Fractures of the clavicle are common injuries that occur across all age groups but are most frequently seen in the young, active patient population. Recent evidence demonstrates that operative treatment of midshaft clavicle fractures can result in. Neer sup3 reported low nonunion rates after nonoperative treatment of midshaft clavicle fracture of 0. Conservative vs operative management of displaced midshaft. Treatment of these fractures is usually nonsurgical. We performed a metaanalysis of studies that have reported on outcomes after superior or anteroinferior plate fixation for acute midshaft clavicle fractures orthopaedic trauma association 15b.
Surgical management of displaced midshaft clavicle fracture in. The clavicle is an sshaped bone and is the only osseous link between the upper extremity and the trunk. Nov 15, 2018 fractures of the clavicle are common injuries that occur across all age groups but are most frequently seen in the young, active patient population. These include those with fractures of the clavicle in the adult. What are the advantages of operative treatment of closed displaced clavicle shaft fractures in adolescents. Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle. However, recently it has been reported that nonoperative management of. Evidence based management of midshaft clavicle fractures kenneth g. This is in contrast to the overall demographics of clavicle fractures, which commonly occur in men in their early 30s, with simple fall being the most common mechanism of injury. Jan 18, 2012 in children, up to 90% of clavicle fractures are midshaft fractures 3. Risk factors for nonunion after nonoperative treatment of. David sheps biography and disclosureswhat i did before during my residency training saskatchewan 1997 2002, the traditional teaching around midshaft clavicle fractures was that these fractures were best left alone, as surgical management was. Nonoperative treatment is known to be the mainstay of management of acute medial clavicle fracture 5, 9. Nonoperative treatment can lead to shortening, a risk factor for nonunion and poor functional outcomes.
Whereas many midshaft clavicle fractures can be treated nonsurgically, recent evidence suggests that more severe fracture types exhibit. However, recent wellconducted studies demonstrate that plate fixation of displaced midshaft clavicle fractures may result in improved functional outcome and a lower rate of malunion and nonunion, compared. If age 12 years and shortened 2 cm refer to orthopaedics for opinion. Management of midshaft clavicle fractures in adults. When operative reduction and fixation is indicated, there are numerous techniques to aid the surgeon patient care. Injuries are usually the result of a fall on an outstretched hand with the force transmitted up the arm. Pdf clavicle fractures are common fractures and the optimal treatment strategy. However, newer studies have shown that malunion, pain, and deformity rates may be higher than previously reported with traditional management. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures a randomized, controlled, clinical trial. To guide pch ed staff with the assessment and management of clavicle fractures in children.
Historically, nonoperative treatment of midshaft clavicular fractures was considered the. These facts may support a primarily nonoperative management of midshaft clavicle fractures in most cases. Whereas many midshaft clavicle fractures can be treated nonsurgically, recent evidence suggests that more severe fracture types exhibit higher rates of symptomatic nonunion or malunion. The majority of clavicle fractures are midshaft injuries, although fractures of the distal or medial fragment also occur. Adolescent displaced midshaft clavicle fracture journal of hand.
However, recent studies have suggested improved clinical out comes with open reduction internal fixation orif of clavicle fractures. Pdf nonoperative treatment of midshaft clavicle fractures. The value of radiography in the followup of extremity fractures. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks. The problem clavicle fractures are common injuries, accounting for 815% of all fractures in children and adults. The clavicle is the most commonly broken bone in the human body, accounting for up to 5% to 10% of all fractures seen in hospital emergency admissions. Costeffectiveness of operative versus nonoperative. Clavicle fracture broken collarbone has seen in all ages, but the midshaft clavicle fracture is the most common in adults. The infant, child, or adolescent with a clavicle fracture usually has a history of trauma.
Pdf clavicle fractures are common fractures and the optimal treatment strategy remains debatable. If displaced, the lateral fragment is usually pulled down by weight of limb and the medial fragment tends to be displaced upwards by the action of the sternocleidomastoid muscle. Clinical scenarios were created for each set of radiographs, and the evaluators were asked to 1 measure the degree of shortening in millimeters, 2 determine. Midshaft fracture commonly occurs in young adult whereas lateral and medial end clavicle fracture is more common in elderly 4,5.
Jan 31, 2011 fractures of the clavicle le kim trong md. Traditional treatment of midshaft clavicle fractures is usually nonoperative management, using a sling or figureofeight bandage. This study was designed to systematically summarize and compare results of different treatment options nonoperative, operative extramedullary fixation, and operative intramedullary fixation in the management of midshaft clavicle fractures, specifically for displaced fractures. Fractures of clavicle are common injuries in adults, accounting for 5% of all fractures and 44% of all shoulder fractures. Millett, md, msc steadman philippon research institute, vail, co, usa clavicle fractures are common in adults and children. The traditional treatment of displaced midshaft clavicle fracture is nonoperative management.
The pdf of the article you requested follows this cover page. There is no agreement on the best treatment for displaced midshaft clavicle fractures mcfs, which are currently addressed by nonoperative or surgi. Robinson, bmedscihons, frcsed investigation performed at the edinburgh shoulder clinic, the royal in. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Kreher, md, boston university, boston, massachusetts c lavicle fractures constitute 5 patient information. Complications of intramedullary hagie pin fixation for acute midshaft clavicle fractures.
There are 3 main options for surgical management of midshaft clavicle fracture. Half of all paediatric clavicle fractures occur under the age of seven years. The emphasis of this article is on the management of these injuries. Management of midshaft clavicle fractures remains controversial. David sheps biography and disclosureswhat i did before during my residency training saskatchewan 1997 2002, the traditional teaching around midshaft clavicle fractures was that these fractures were best left alone, as surgical management was felt to be fraught with complications and poor outcomes. Fractures clavicle kids health wa pmh ed guidelines. Historically, only unstable distal clavicle fractures were treated operatively.
Nonoperative treatment of midshaft clavicle fractures in. The focus of treatment of middle third fractures remains nonoperative, although evidence is mounting, in support of operative treatment for displaced midshaft clavicle fractures. Medical management of displaced midshaft clavicle fractures. Churchill, the anderson orthopaedic clinic, alexandria, va dr. This includes fractures of the midshaft, medial or lateral clavicle. Operative versus nonoperative treatment of midshaft clavicle. The majority of clavicle fractures are treated conservatively. A fractured clavicle, or fractured collarbone, is a common sports injury that generally occurs from an impact to the shoulder of a fall on an outstretched arm. Jan 14, 2019 the focus of treatment of middle third fractures remains nonoperative, although evidence is mounting, in support of operative treatment for displaced midshaft clavicle fractures. Give parent fracture of the clavicle collarbone fact sheet.
Although the indications for surgical fixation of midshaft clavicle fractures remain controversial, they. Following a clavicle fracture, a figureofeight clavicle strap, along with a sling, is fitted to the. Among the different types of clavicle fractures, those occurring in the middle third of the clavicular shaft are the most common. Typically, there is localized pain over the fracture, with associated edema and crepitus.
Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it snaps or breaks. These fractures may be partial or complete and often require surgical repair and immobilization while they heal. Jan 01, 2008 displaced midshaft clavicle fractures have higher rates of nonunion and a greater risk of longterm sequelae. Lateralthird fractures are less common, accounting for approximately 25% of all clavicle fractures, and are less likely to be displaced than those occurring in the midshaft. Eleven patients with bipolar clavicle injuries, including dislocation of both ends of the clavicle, dislocation of the sternoclavicular joint with distal clavicle fracture, dislocation. Among the different types of clavicle fractures, those occurring in the middle third of the. A midshaft clavicle fracture resulting from a groundlevel fall onto an outstretched arm may indicate.
Clavicle fractures, midshaft, adult, treatment, conservative, adults. Surgical management of displaced midshaft clavicle. To compare the outcomes of clavicle fracture fixation using anteroinferior versus superior plate placement. If you continue browsing the site, you agree to the use of cookies on this website.
Historically, nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care. Introduction clavicle fractures occur commonly, often as a result of indirect or direct trauma to the shoulder region. Fractures of the distal fractueas of the clavicle with coracoclavicular ligament disruption have been associated with delayed union or nonunion. Correct measurement of clavicular length is essential, and reliable measures of clavicular length are therefore highly requested by clinical decisionmakers. Jul 15, 2014 fracture classification allman classification. Clinicians working in emergency departments and general clinics should be familiar with the common presentations and complications of this injury, as well as basic management. Treatment with an arm sling is preferred over a figureofeight dressing for acute midshaft clavicle fractures because it is better tolerated and. Clavicle fractures are among the most common skeletal injuries accounting for 25% of all adult fractures. The aim of this study was to investigate if three commonly scientifically used measurement methods were interchangeable to each. Deforming forces on displaced midshaft clavicle fracture.