The mechanism of clavicular fracture. A clinical and biomechanical analysis

Stanley, David; Ea, Trowbridge; Sh, Norris

doi:10.1302/0301-620x.70b3.3372571

Cited by 251 publications

(159 citation statements)

References 11 publications

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“…Stanley et al explained the mechanism of clavicular fracture as due to blunt shoulder trauma [26]. This fits in with our hypothesis on lateral impaction forces and in fact may be an early stage of lateral impaction injury.…”

Section: Discussionsupporting

confidence: 91%

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The lateral impaction of the shoulder

Scarlat¹,

Cuny²,

Goldberg

et al. 1999

International Orthopaedics

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17 patients had radiographic demonstration of injury to the clavicle, scapula and ribs from an impact delivered to the lateral shoulder. The study included 13 males and 4 females whose ages ranged from 18 to 83 years (average 45 years). Most injuries were sustained in falls or motor vehicle accidents. Analysis of these cases suggests a biomechanical hypothesis concerning the transmission of the impact forces within the shoulder girdle. According to this hypothesis, the impaction force applied to the lateral shoulder is transmitted from outside inward following two paths. The anterior and superior path passes through the acromio-clavicular joint, the clavicle, the costo-clavicular joint and the sterno-clavicular joint. The posterior and inferior path is transmitted within the gleno-humeral joint, the scapula and the scapulo-thoracic joint. Major impacting force is required to disrupt the anterior and posterior arches of the shoulder girdle. When both of these supporting structures are damaged, the patient is at risk for more serious injuries, including disruption of the thorax, shoulder joint, brachial plexus and neck.Résumé Les auteurs communiquent l'observation des caractéristiques communes pour 17 cas de traumatismes complexes de l'épaule, associant comme lésions des fractures de la clavicule de l'omoplate et des côtes. L'analyse des cas suggère une hypothèse biomécanique concernant la transmission des forces d'impaction traumatique au niveau de la ceinture scapulaire. Conformément a cette hypothèse, la force traumatique appliqué sur la face externe de l'épaule est transmise de l'extérieur vers l'intérieur sur deux voies vectorielles. La voie antéro-supérieure passe par l'articulation acromio-claviculaire, la clavicule, l'articulation costo-claviculaire et l'articulation sterno-claviculaire. La voie postéro-inférieure passe par l'articulation gléno-humérale, l'omoplate et le complexe scapulo-thoracique. Théoriquement, les lésions peuvent se produire sur tout point du trajet vectoriel. En particulier, les lésions peuvent se manifester au niveau de l'arche antérieure ou postérieure du cintre omocle-thoracique, en extérieur et a l'intérieur du cintre.

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Section: Discussionsupporting

confidence: 91%

“…Trauma to the lateral aspect of the shoulder is not uncommon [5,8,13,26]. Usually the force applied to the shoulder girdle is relatively mild, resulting in isolated lesions of the clavicle or of the acromion-clavicular joint.…”

Section: Introductionmentioning

confidence: 99%

The lateral impaction of the shoulder

Scarlat¹,

Cuny²,

Goldberg

et al. 1999

International Orthopaedics

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“…A high energy injury is common reported mechanism of injur that produces a midshaft fracture of the clavicle. [18][19][20][21] In addition, high energy injury like that resulting from a traffic accident is increasing and survivorship of patients from high energy trauma is also improving. 6) As a result, cases of clavicular fracture with accompanying injuries rather than an isolated clavicular fracture are increasing.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Outcome after Surgical Treatment in Displaced Clavicular Midshaft Fracture

Gwak¹,

Kim²

2016

Clinics in Shoulder and Elbow

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Background: The first purpose of this study is to compare the clinical and radiological outcomes of surgical treatment for displaced midshaft clavicle fracture (Robinson type 2B1 vs. 2B2) with 3.5-mm low profile clavicular locking compression plate. The second purpose is to evaluate the difference of the results depending on the presence of accompanying injuries. Methods: Forty-nine patients who underwent an operation for the fractures were reviewed retrospectively. Fracture patterns were classified according to group 2B1 and 2B2 using Robinson's classification. For radiological outcome, time to union after operation was evaluated and for clinical outcome, American Shoulder and Elbow Society (ASES) score, University of California in Los Angeles (UCLA) score, visual analogue scale (VAS), and range of motion (ROM) were evaluated from preoperative period to last follow-up period. Results: The mean time for union was not significantly different in the 2B1 group and 2B2 group (p=0.062). No statistically significant difference in ASES score, UCLA score, and VAS was observed between 2B1 and 2B2 (p=0.619, p=0.896, p=0.856, respectively). In ROM, significant higher mean forward flexion and abduction was observed in 2B2 (p=0.025, p=0.017, respectively) and there was no difference in external rotation and external rotation at shoulder

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“…Traditionally, these fractures have been treated non-operative [2][3][4][5][6]. This traditional treatment is not without complications, including shortening, nonunion, deformity and unsatisfactory patient outcomes [7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%