Daily Bolus of LR: Clavicle fractures

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February 17, 2011 by dailybolusoflr

Clavicle fractures account for about 5% of all fractures and are more common in children, being the most common pediatric fracture. 

 

Given the proximity of the clavicle to the subclavian vessels, the brachial plexus and even the dome of the lung, one must consider associated injuries when examining a patient with a clavicle fracture.  This is especially the case when there is inferior displacement of the clavicle. 

 

Significantly displaced fractures should be evaluated for the need for surgical repair.  This is especially true for the less common medial and lateral 1/3 fractures. 

 

Middle Third:

·         Fractures occur most commonly in the middle third of the clavicle and account for about 80% of clavicle fractures. 

·         The most common mechanism involves a direct force to the lateral aspect of the shoulder. 

·         When these fractures are displaced, the typical type of displacement is the medial fragment upwards and is due to the force exerted by the sternocleidomastoid.  Note the attachment of the sternocleidomastoid muscle is to the medial aspect of the clavicle.

·         Fractures that have more than 2cm of shortening and significantly displaced fractures are at the most highest risk for malunion and nonunion.

Medial Third:

·         Fractures of the medial third of the clavicle account for about 5% of clavicle fractures and result from a direct blow to the anterior chest. 

Lateral Third:

·         Fractures of the lateral third of the clavicle account for the remaining 15% of clavicle fractures. 

·         These usually result from a direct blow to the top of the shoulder. 

·         These fractures are distinguished by their location. 

§  Type 1 fractures are stable and occur lateral to the coracoclavicular ligament. 

§  Type 2 fractures are medial to the coracoclavicular ligament and usually result in superior displacement of the proximal portion. 

§  Type 3 fractures involve the articular surface. 

 

 

Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions

 

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