Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle. Jul 15, 2014 fracture classification allman classification. Management of midshaft clavicle fractures in adults. The clavicle is an sshaped bone and is the only osseous link between the upper extremity and the trunk. 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.
Typically, there is localized pain over the fracture, with associated edema and crepitus. Clavicle fractures are among the most common skeletal injuries accounting for 25% of all adult fractures. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks. These facts may support a primarily nonoperative management of midshaft clavicle fractures in most cases.
If age 12 years and shortened 2 cm refer to orthopaedics for opinion. Surgical management of displaced midshaft clavicle. A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. 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. A midshaft clavicle fracture resulting from a groundlevel fall onto an outstretched arm may indicate. Most clavicle fractures do not require orthopaedic follow up. Nagda, and the hospital of the university of pennsylvania, philadelphia, pa dr. Historically, nonoperative treatment of midshaft clavicular fractures was considered the.
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. 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. Nonoperative treatment is known to be the mainstay of management of acute medial clavicle fracture 5, 9. When operative reduction and fixation is indicated, there are numerous techniques to aid the surgeon patient care. Historically, only unstable distal clavicle fractures were treated operatively. There is no agreement on the best treatment for displaced midshaft clavicle fractures mcfs, which are currently addressed by nonoperative or surgi. An evaluation of treatment options for medial, midshaft. Pdf clavicle fractures are common fractures and the optimal treatment strategy remains debatable. Neer sup3 reported low nonunion rates after nonoperative treatment of midshaft clavicle fracture of 0. What are the advantages of operative treatment of closed displaced clavicle shaft fractures in adolescents. Treatment with an arm sling is preferred over a figureofeight dressing for acute midshaft clavicle fractures because it is better tolerated and. Medical management of displaced midshaft clavicle fractures. The majority of clavicle fractures are managed with analgesia and a broad arm sling.
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. Deforming forces on displaced midshaft clavicle fracture. Nonoperative treatment compared with plate fixation of. Adolescent displaced midshaft clavicle fracture journal of hand. There are 3 main options for surgical management of midshaft clavicle fracture. 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. The majority of adults treated nonoperatively for midshaft clavicle fractures will heal completely. Nonoperative treatment of midshaft clavicle fractures in. Middle third most common broad arm sling to support limb for 2 weeks or until comfortable. Millett, md, msc steadman philippon research institute, vail, co, usa clavicle fractures are common in adults and children.
They are caused by direct trauma, falls on the shoulder, or falls onto an. However, newer studies have shown that malunion, pain, and deformity rates may be higher than previously reported with traditional management. Clavicle fractures account for 5% to 15% of childhood fractures, and are the most common type of fracture in children. Kreher, md, boston university, boston, massachusetts c lavicle fractures constitute 5 patient information. Costeffectiveness of operative versus nonoperative. The clavicle, also referred to as the collarbone, is a long bone located at the top of the chest. 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.
Management of midshaft clavicle fractures remains controversial. Evidence based management of midshaft clavicle fractures kenneth g. Nonoperative treatment of midshaft clavicle fractures in adults. Eleven patients with bipolar clavicle injuries, including dislocation of both ends of the clavicle, dislocation of the sternoclavicular joint with distal clavicle fracture, dislocation. The pdf of the article you requested follows this cover page. 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. Clavicle shaft fracture pediatric pediatrics orthobullets. Although the indications for surgical fixation of midshaft clavicle fractures remain controversial, they. Fractures of the distal fractueas of the clavicle with coracoclavicular ligament disruption have been associated with delayed union or nonunion. Midshaft clavicle fractures this changed my practice.
Plate fixation of middlethird fractures of the clavicle in the semiprofessional athlete. 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. Clavicle fracture broken collarbone orthoinfo aaos. To guide pch ed staff with the assessment and management of clavicle fractures in children. Pdf clavicle fractures are common fractures and the optimal treatment strategy.
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. Adolescents who sustained closed mid shaft clavicle fractures between 2000 and 2008 were identified in our institutional trauma registry. Nonoperative treatment can lead to shortening, a risk factor for nonunion and poor functional outcomes. Give parent fracture of the clavicle collarbone fact sheet. However, recently it has been reported that nonoperative management of. Trauma is the most common cause of a clavicle fracture. 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. Historically, nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care. The intramedullary osteosynthesis of the diaphyseal fracture of the clavicle compared to conservative treatment. Studies of nonoperative treatment of completely displaced, midshaft fractures of the clavicle reveal nonunion rates between 15% and 20% 5,6. The majority of clavicle fractures are treated conservatively. 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.
Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Among the different types of clavicle fractures, those occurring in the middle third of the. The art of femoral fracture care involves a balancing act between anatomic alignment and early functional rehabilitation of the limb. Jan 18, 2012 in children, up to 90% of clavicle fractures are midshaft fractures 3. Whereas many midshaft clavicle fractures can be treated nonsurgically, recent evidence suggests that more severe fracture types exhibit.
Injuries are usually the result of a fall on an outstretched hand with the force transmitted up the arm. To compare the outcomes of clavicle fracture fixation using anteroinferior versus superior plate placement. Clavicle fractures are common in adults and children. Clavicle fractures matthew pecci, md, and jeffrey b. Surgical management of displaced midshaft clavicle fracture in.
Background management of displaced midshaft clavicle fractures is controversial. Jan 01, 2008 displaced midshaft clavicle fractures have higher rates of nonunion and a greater risk of longterm sequelae. Patients with persisting pain or a delayed course under conservative treatment may be candidates for early secondary surgery. Most commonly, these fractures occur within the middle third of the clavicle and exhibit some degree of displacement. However, recent studies have suggested improved clinical out comes with open reduction internal fixation orif of clavicle fractures.
There has been a shift towards surgical management of displaced midshaft clavicle fractures in adults over last decade. Treatment of these fractures is usually nonsurgical. Recent evidence demonstrates that operative treatment of midshaft clavicle fractures can result in. This includes fractures of the midshaft, medial or lateral clavicle. Jan 31, 2011 fractures of the clavicle le kim trong md. Pdf nonoperative treatment of midshaft clavicle fractures. The infant, child, or adolescent with a clavicle fracture usually has a history of trauma. 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. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle i. Clavicle fracture introduction clavicle fractures are a common orthopedic injury, particularly among infants and young children.
The value of radiography in the followup of extremity fractures. Management of medial clavicle fractures also has remained nonoperative. These include those with fractures of the clavicle in the adult. However, the challenge is the identification of patients who might benefit from surgical fixation. 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. 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.
In a single center, prospective clinical trial, 60 patients with displaced midshaft fracture of the clavicle were systematically randomized. Evidence based management of midshaft clavicle fractures. Midshaft fracture commonly occurs in young adult whereas lateral and medial end clavicle fracture is more common in elderly 4,5. Correct measurement of clavicular length is essential, and reliable measures of clavicular length are therefore highly requested by clinical decisionmakers. Clavicle fractures, midshaft, adult, treatment, conservative, adults. Traditional treatment of midshaft clavicle fractures is usually nonoperative management, using a sling or figureofeight bandage. These fractures may be partial or complete and often require surgical repair and immobilization while they heal. Fractures of the middle third, or midshaft, are the most common, accounting for up to 80% of all clavicle fractures. Most common approximately 80% in both adults and children. 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. Medialthird fractures comprise the remaining 2% to 3% of these injuries. 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. In 1987 andersen et alreported less discomfort and a trend towards fewer complications with a.
Fractures of the clavicle are common injuries that occur across all age groups but are most frequently seen in the young, active patient population. A fracture of the clavicle is a relatively common injury that occurs in patients of all ages. The majority of clavicle fractures are midshaft injuries, although fractures of the distal or medial fragment also occur. 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. The clavicle is the most commonly fractured long bone in children. The problem clavicle fractures are common injuries, accounting for 815% of all fractures in children and adults. Following a clavicle fracture, a figureofeight clavicle strap, along with a sling, is fitted to the. Introduction clavicle fractures occur commonly, often as a result of indirect or direct trauma to the shoulder region.
The majority of clavicle fractures can heal without surgery. Among the different types of clavicle fractures, those occurring in the middle third of the clavicular shaft are the most common. Fractures of clavicle are common injuries in adults, accounting for 5% of all fractures and 44% of all shoulder fractures. No evidence to support figure of 8 bandage or brace. The aim of this study was to investigate if three commonly scientifically used measurement methods were interchangeable to each. Classical operative treatment indications are open fractures, compromised skin, neurovascular complications or an additional fracture of the. Half of all paediatric clavicle fractures occur under the age of seven years. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures a randomized, controlled, clinical trial. Fractures clavicle kids health wa pmh ed guidelines. Historically, nonoperative treatment of midshaft clavicular fractures was. 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. 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.
More than 200 methods of operative and nonoperative methods for management of clavicle fractures have been described 6. Clavicle fracture an overview sciencedirect topics. Risk factors for nonunion after nonoperative treatment of. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. Intramedullary fixation of midshaft clavicle fractures. Operative versus nonoperative treatment of midshaft clavicle. 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. Conservative vs operative management of displaced midshaft. 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. 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.
Reported outcomes of surgical treatment of midshaft. The emphasis of this article is on the management of these injuries. Churchill, the anderson orthopaedic clinic, alexandria, va dr. Clavicle fracture rehabilitation protocol justin w griffin, md. The focus of treatment of middle third fractures remains nonoperative, although evidence is mounting, in support of operative treatment for displaced midshaft clavicle fractures.
Nov 01, 2015 surgery and conservative treatment acute clavicle fractures were traditionally treated nonoperatively. Robinson, bmedscihons, frcsed investigation performed at the edinburgh shoulder clinic, the royal in. Displaced fractures of the clavicle may be treated nonoperatively in selected cases. Traditional treatment of midshaft clavicle fractures is usually nonoperative management, using a sling or figureofeight. Clavicle fracture broken collarbone has seen in all ages, but the midshaft clavicle fracture is the most common in 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. The traditional treatment of displaced midshaft clavicle fracture is nonoperative management. If you continue browsing the site, you agree to the use of cookies on this website. Considering these uncertainties, surgeons are faced with a difficult decision regarding whether operative treatment of a midshaft clavicle fracture will be costeffective.
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