Management of Distal Clavicle Fractures

Abstract

Most clavicle fractures heal without difficulty. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Type II distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion. Several studies have questioned the clinical relevance of distal clavicle nonunion, however. Nonsurgical and surgical management provide similar results. The decision whether to operate may be influenced by the amount of fracture displacement and the individual demands of the patient. Surgical options to achieve bony union include transacromial wire fixation, a modified Weaver-Dunn procedure, use of a tension band, screw fixation, plating, and arthroscopy. Each technique has advantages and disadvantages; insufficient evidence exists to demonstrate that any one technique consistently provides the best results.

Common Injuries in Professional Football Quarterbacks

“…Fractures lateral to the coracoclavicular ligaments are stable and are typically treated non-operatively. Fractures involving the coracoclavicular ligaments or medial to these ligaments are unstable and require open reduction and internal fixation [19,20].…”

Clavicle Anatomy

“…Distal clavicle fractures have a higher incidence of non-union than mid-shaft fractures, with fi gures as high as 40 % reported [ 15 ]. Factors associated with non-union are increasing age and fracture displacement, but the majority of these (70 %) non-unions tend to be minimally symptomatic with no difference in functional score compared to if union had occurred [ 16 ].…”

Fractures of the Clavicle

“…In order to achieve coracoclavicular stability in Type II or III fractures, it is advisable to use an extra suture or tight rope system in combination with the plate (Figs. 8, 9, 10, and 11) (Banerjee 2011).…”

“…Fracture of the medial clavicle is generally treated nonoperatively, besides they are openly or severely displaced (Banerjee 2011).…”