Fractures of the clavicle in the adult

Abstract

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.

Segmental clavicle fracture and acromio-clavicular joint disruption: an unusual case report

“…The most common mechanism of injury is a direct force to the clavicle or a fall onto the outstretched arm. 2,3 We describe a most unusual segmental fracture pattern of the clavicle with concurrent disruption of acromioclavicular (AC) joint not previously known by ourselves. It was successfully treated with a medial anatomic plate and lateral hook plate.…”

Regional Anesthesia for the Trauma Patient

“…Documentation of any radial nerve injury is important prior to proceeding with a regional anesthetic technique, especially with midhumeral shaft fractures in which the radial nerve may be injured from the trauma as it courses posteriorly alongside the humerus in the spiral groove [Ekholm et al, 2006]. Clavicle fractures also occur in the younger population and are usually related to direct or indirect trauma to the clavicle, commonly due to traffic accidents or a sports-related injury [Pecci et al, 2008;Postacchini et al, 2002;Robinson et al, 1998]. The humerus receives its innervation from the brachial plexus.…”

Plating: A Rational Option for Mid Shaft Clavicle Fractures

“…Medial third fractures are the rarest and accounts for 5% , perhaps because of the difficulty in accurately imaging (and identifying) them 4,5 . The most common reported mechanism of injury that produces a midshaft fracture of the clavicle, is a direct blow on the point of the shoulder 6,7 . Robinson 6 reported in an epidemiologic study that the annual incidence in males was highest in the under-20 age group, decreasing with each subsequent age cohort.…”