x Clavicle Fractures JB.docx
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Clavicle Fractures
Description
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Figure 1: The left clavicle as seen from above. The sternum is medial and the acromion is lateral. The points of muscular attachment are color-coded: medially, the sternocleidomastoid is red and the pectoralis is green; laterally the deltoid is yellow and the trapezius is orange. (modified from https://en.wikipedia.org/wiki/Clavicle#/media/File:Gray200.png)
When the clavicle is fractured, the proximal (medial) portion can be pulled superiorly by the sternocleidomastoid muscles, while the distal portion is pulled inferiorly by the weight of the arm. The fracture fragments can also be displaced anteriorly or posteriorly, leading to tenting and necrosis of the overlying skin or neurovascular injury, respectively.
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Figure 2: A distal (lateral) clavicle fracture (red arrow) may be in the region (green star) of the ligaments that attached the clavicle to the scapula. (from https://radiopaedia.org/cases/22256)
A neurovascular and respiratory exam is critical to rule out injury to the brachial plexus, subclavian vessels, or the lungs. Strength, sensation, pulses and difficulty of breathing should be assessed.
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Figure 3: A mid-shaft clavicle fracture (Case courtesy of A. Prof Frank Gaillard, https://radiopaedia.org/ From the case https://radiopaedia.org/cases/18050,)
Figure 4: Shortening of the clavicle can be assessed by measuring the distance between the ends of the medial and lateral fragments or by direct comparison to the contralateral side. (from https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1881-x)
Arteriography may be helpful in evaluating vascular injury.
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Figure 5: A clavicle fracture fixed with a plate. (from https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-15-380)
Any displacement of distal third fractures may be an indication for surgical treatment as the displacement implies a concomitant ligament injury and higher risk of non-union.
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