Clavicle fractures are commonly caused by falls on the shoulder or outstretched hand. They are classified based on location (medial, middle, lateral). Most are managed non-operatively with a sling or figure-of-eight bandage. Early surgery is indicated for fractures in young patients from high-energy trauma, comminuted fractures, fractures with skin jeopardy, or >20mm of shortening. Floating shoulder injuries and open or lateral fractures also typically require surgery. Surgical management involves open reduction and internal fixation followed by a short period of protected motion and early return to sports. Studies show reliable healing and functional outcomes when surgery is performed for appropriately indicated fractures.

1. Clavicle Fractures
Puneet Monga
MAC Educational meet Aug’13

2. Mechanism of Injury

3. Mechanisms
Fall on the shoulder
Fall on outstretched
hand

4. Displacement

5. Presentation
• Look for Skin under
jeopardy
• Neuro-vascular injury

6. Classification

7. Classification
Classified by thirds (Medial, Middle and Lateral)
Most Common

8. Management

9. Non operative
Majority non-operative management
Sling vs Figure of 8 bandage
• Prospective randomized trial of 61 patients
• Simple sling-Less discomfort
• Functional and cosmetic results identical
• Alignment of healed fractures unchanged from the initial
displacement in both groups
Andersen et al., Acta Orthop Scand 58: 71-4, 1987.

10. Indications for
surgery
Young patients with high energy trauma

11. Comminuted
fractures

12. Skin under jeopardy

13. Bony overlap
> 20 mm shortening associated with increased risk of nonunion and poor functional
outcome at 3 years (Hill et al, JBJS 1997: 79B: 537-9)

14. Floating shoulder

15. Floating shoulder

16. Open fractures
Surgical Emergency

17. Lateral end fractures

18. Lateral end fractures

19. Surgical
management
Open Reduction and Internal Fixation

24. Post-op
• Protect Soft tissues 2 weeks.
• Build up as able; Early return to sports

25. Outcomes

26. Our results
• 70 clavicle fractures
• 3 plate fractures
• 2 loosening
Sinnott, Monga. Audit of Clavicle Fractures, WWL NHS Trust 2012

27. Summary
Early surgery for
with
and leads to
&
reliable
in the absence of