- See: 
-
Clavicular Frx in Children: /
Congential Pseudoarthrosis of Clavicle:
-
AC joint /
Sternoclavicular Joint Injury: / Scapula
Fracture:
- Discussion and
Classification:
- Exam Findings:
-
brachial plexus
- ref: Injury
to the brachial plexus by a fragment of bone after fracture of the clavicle
- Radiology: 
-
Serendipity View:
- best visualized w/ AP view & view w/ beam angled 30
deg. cephalad;
- w/ frx of clavicle, distal fragment & arm tend to
sag, while proximal fragment,
held by SC joint tends to point upward;
- in any clavicular frx, carefully scutinize x-rays for
presence of
scapular frx,
which represents a
floating shoulder;
- Non Operative Treatment:
- it is difficult to reduce and maintain the reduction of clavicle
fractures;
- despite deformity, healing usually proceeds rapidly;
- union usually occurs rapidly & produces prominent callus;
- w/ midshaft fractures, there will also be some degree of malunion;
- in
these patients be attentive to
medial cord nerve symptoms (more often
ulnar nerve);
- distal clavicle fractures may have a high incidence of non union
but most of these
are asymptomatic, and of these only a small number will be
severe enough to require surgery;
- references:
-
Treatment of clavicular fractures. Figure-of-eight bandage versus a simple
sling.
-
Recovery following fractures of the clavicle treated conservatively.
-
Primary
Nonoperative Treatment of Displaced Lateral Fractures of the Clavicle.
-
Closed treatment of displaced middle-third fractures of the clavicle gives poor
results.
-
Estimating the
Risk of Nonunion Following Nonoperative Treatment of a Clavicular Fracture.
-
Deficits Following
Nonoperative Treatment of Displaced Midshaft Clavicular Fractures.
-
Shortening of clavicle after fracture: Incidence and clinical significance. A
5-year follow-up of 85 patients.
-
Operative Versus Nonoperative Treatment of Midshaft Clavicle Fractures in
Adolescents
- Operative
Treatment: /
Intramedullary Pin Fixation
- Non Union and Malunion of the Clavicle:
- defined as absence of radiographic healing by 4 months;
- non unions occur in more severe traumatic injuries;
- occurs most often in the central third where the clavicle lacks abundant
muscular coverage;
- in mid-clavicular region, deforming forces include the pectoralis
major (pulls the distal fragment inferiorly
and
medially) and sternocleidmastoid (which is pulled superiorly);
- note that the diagnosis of clavicular non union can sometimes be difficult
(because 2 orthogonal views cannot
be obtained), and the supermposed ends of the clavicle on the AP view can give the false impression of
union;
- exam:
- note function of
brachial plexus
(esp lower trunk);
- r/o presence of
thoracic
outlet syndrome;
- management:
-
intra-medullary clavicular fixation:
-
iliac
crest bone grafting;
- internal or external bone stimulator;
- references:
-
Nonunion of the clavicle and thoracic outlet syndrome.
-
Non-union of fractures of the mid-shaft of the clavicle. Treatment with a
modified Hagie intramedullary pin
and autogenous bone-grafting.
-
Non-union of the clavicle. Associated complications and surgical management.
-
The operative treatment of mid-shaft clavicular non-unions.
-
Surgery for ununited clavicular fracture.
- The treatment of nonunion fractures of the midshaft of the clavicle
with an intramedullary Hagie pin
and autogenous bone graft.
Boehme D. Curtis RJ Jr. DeHaan JT. Kay SP. Young DC.
Rockwood CA Jr. Instructional
Course Lectures. 42:283-90, 1993.
-
Midshaft Malunions of the Clavicle.
-
Short malunions of the clavicle: An anatomic and functional study
-
Brachial Plexus Palsy Secondary to Clavicular Nonunion.