Fractures of the clavicle

Sankaran-Kutty, M.; Turner, Bruce

doi:10.1016/0020-1383(75)90006-6

Cited by 47 publications

(17 citation statements)

References 3 publications

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“…The relative proportion of females to males increased with age; simple falls were the predominant cause of injury in the elderly. These clinical findings are supported by previous biomechanical studies 14,15 which have suggested that the usual mechanism of the fracture, irrespective of site, is a direct force applied to the point of the shoulder such as occurs during a fall or RTA. As Müller has indicated, 16 classification systems are only of value if they serve as a basis for treatment and can be used to predict outcome.…”

Section: Discussionsupporting

confidence: 79%

Fractures of the clavicle in the adult

Robinson

1998

The Journal of Bone and Joint Surgery. British volume

488

140

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F rom 1988 to 1994 a consecutive series of 1000 fractures of the adult clavicle was treated in the Orthopaedic Trauma Clinic of the Royal Infirmary of Edinburgh. In males, the annual incidence was highest under 20 years of age, decreasing in each subsequent cohort until the seventh decade. In females, the incidence was more constant, but relatively frequent in teenagers and the elderly. In young patients, fractures usually resulted from road-traffic accidents or sport and most were diaphyseal. Fractures in the outer fifth were produced by simple domestic falls and were more common in the elderly.A new classification was developed based on radiological review of the anatomical site and the extent of displacement, comminution and articular extension. There were satisfactory levels of inter-and intraobserver variation for reliability and reproducibility. Fractures of the medial fifth (type 1), undisplaced diaphyseal fractures (type 2A) and fractures of the outer fifth (type 3A) usually had a benign prognosis. The incidence of complications of union was higher in displaced diaphyseal (type 2B) and displaced outer-fifth (type 3B) fractures. In addition to displacement, the extent of comminution in type-2B fractures was a risk factor for delayed and nonunion.

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Section: Discussionsupporting

confidence: 79%

Fractures of the clavicle in the adult

Robinson

1998

The Journal of Bone and Joint Surgery. British volume

488

140

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“…Oroko et al (1999) studied 41 patients with clavicle fractures and could not demonstrate any relationship between the two. Sankarankutty and Turner (1975) reviewed 215 cases of shortened clavicles, and found no cases exhibiting loss of muscle power at the shoulder.…”

Section: Sternalmentioning

confidence: 98%

Anatomy of the clavicle and the intramedullary nailing of midclavicular fractures

et al. 2006

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Intramedullary fixation is used increasingly to treat clavicular fractures. Anatomical variations in the clavicle of relevance to this procedure are analyzed. The length, diameters and curvature of the clavicle were measured in 196 specimens from the dissecting room. The calcium bone density was analyzed in 300 cross-sectional samples of 100 specimens. The thickness of cortical and medullary bone of 70 slices was analyzed from freshly plastinated clavicles with implants in place. The female clavicle was shorter, less curved, and had a lower concentration of calcium than the male clavicle. Measurement of cortical thickness showed a mean value of 1.05 +/- 0.23 mm at the most sternal measuring point, 2.05 +/- 0.29 mm at the midpoint of the clavicle, and 0.95 +/- 0.35 mm at the acromial end. The thinnest regions were the medial ventral cortex and the dorsal acromial cortex. These measurements explain clinical observations on nail perforation. The diameter of the medullary canal measured 6.7 +/- 2.6 mm at its narrowest part, so that reaming (i.e., predrilling the medullary canal) prior to 3.5 mm titanium nail insertion is not necessary. The main difficulties encountered when placing a nail are secondary to the S-curvature of the clavicle. In 80% of fractures, the break is located at the narrowest diameter of the medullary canal. Thus, the clavicle displays definite gender- and side-specific anatomical features in terms of length, diameter, curvature, and calcium concentration. These should be considered when performing intramedullary fixation.

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“…Looking at the finer results it has been reported that conservative management has more chance of mal-union and non-union. 2,[7][8][9][10][11] A pooled data revealed that nonunion was lower in operated group as compared to conservative group, Also showed that 14% of 452 patients in the Non-operative group developed a nonunion, which is Significantly higher (p=0.00001) than the 1.7% rate of Non-union in the 507 patients of the operative group. Symptomatic mal-union was also significantly more common in the nonoperative group (20% in the nonoperative group versus 1.8% in the operative group.…”

Section: Discussionmentioning

confidence: 94%

“…Even united or not most patients have good functional outcomes and a high level of patient satisfaction except few where there is functional disability following nonunion. 2,[7][8][9][10][11] As nonoperative treatment are not as favourable as once thought, there is increase trend for internal fixation. [12][13] Besides non-union was lower in operated group as compared to conservative group, pooled data showed that 14% of 452 patients in the nonoperative group developed non-union, which is significantly higher (p=0.00001) than the 1.7% rate of non-union in the 507 patients of the operative group.…”

Section: Introductionmentioning

confidence: 99%

Fracture union and complication following internal fixation of clavicle by plate and screw

2016

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INTRODUCTIONClavicle is the only bone that is most neglected in a polytrauma patient. But its importance was more convincing after dealing floating shoulder injuries. When there was both clavicle and scapular fracture more attention was given to clavicle fracture to maintain the leverage action of shoulder. Clavicle fracture amounts to 2.6% of all fractures and accounts for 34% to 45% of shoulder girdle injuries in adults.1-3 Of all clavicle fractures it is most common in middle one third i.e. about 69% to 81%, lateral one-third 17% and medial one-third 2%. 4,6 Most of the clavicles fractures are treated nonoperatively, results vary from good union, mal-union to non-union. Even united or not most patients have good functional outcomes and a high level of patient satisfaction except few where there is functional disability following nonunion. 2,7-11As nonoperative treatment are not as favourable as once thought, there is increase trend for internal fixation. 12-13Besides non-union was lower in operated group as compared to conservative group, pooled data showed that 14% of 452 patients in the nonoperative group developed non-union, which is significantly higher (p=0.00001) than the 1.7% rate of non-union in the 507 patients of the ABSTRACT Background: Among all long bones clavicle is the only bone placed horizontally and has membranous ossification. Clavicle fractures accounting for about 2.6% of total body fractures and 34% to 45% of total shoulder girdle injuries in adults. Most fractures occur in middle third of clavicle and common in young male patients. It has wide range of management from conservative to variant internal fixation. Each procedure has its own outcome and complications. We tried to find out the outcome and complications following internal fixation of clavicle with plate and screws. Methods: In a prospective study 50 patients of fracture mid shaft clavicle who were treated with plate and screw were followed for a period of two years. Only adults more than 18 years were included in the study. All patients were followed at 2 nd post-operative day 5 th post-operative day 14 th post-operative day and at 1, 2, 6, 12 and 24 months. Only two parameters were observed i.e. union of fracture and post-operative complications. Results: Of all patients operated with plate and screw 48 patients had good radiological union by six months. Only two patients had non-union and one with implant failure at 12 months. Of complications one had stitch abscess and seven had hardware discomfort. Conclusions: Clavicle fracture in adults has multimodal treatment option. Though conservative management has good results it has high chance of mal-union and non-union. Operative fixation should be opted for adult individuals where chance of non-union is high. Plate and screw fixation has good results in terms of union with least complication.

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Fractures of the clavicle

Cited by 47 publications

References 3 publications

Fractures of the clavicle in the adult

Fractures of the clavicle in the adult

Anatomy of the clavicle and the intramedullary nailing of midclavicular fractures

Fracture union and complication following internal fixation of clavicle by plate and screw

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