11/8/2023 0 Comments Clavicle fracture![]() ![]() The sternocleidomastoid displaces the proximal fragment upward. The shoulder is typically pulled downward in patients with fractures of the middle third of the clavicle, due to the effect of the pectoralis major and latissimus dorsi muscles on the distal fragment. On physical examination, the patient may present with a visible or palpable deformity over the fracture site. A direct blow to the clavicle or a fall on an outstretched hand are less common mechanisms. The most common reported mechanism is a fall onto the lateral shoulder. Patients may report a snapping or cracking sound when the injury occurs. The affected extremity is typically held close to the body. Patients with clavicle fractures typically present with well-localized pain over the fracture site. Clavicle fractures do occur in isolation but when there is a high energy injury one should always look for associated injuries like a pneumothorax, hemothorax, and head trauma. ![]() There seems to be no correlation between the clavicular fracture site and the mechanism of injury. Approximately 40 percent of injuries caused by traffic accidents occur in cyclists, more than 25 percent in car drivers or passengers, 17 percent in motorcyclists, and 17 percent in pedestrians. Most of these fractures among the young occur in a traffic accident or a sports injury. More than 85 percent of clavicular fractures occur by a fall onto the shoulder. In addition, the brachial plexus also course behind the clavicle and are at risk when there is a fracture of the middle clavicle. The subclavian artery passes anterior to the first rib and is in close proximity with the middle segment of the clavicle. Many important structures are adjacent to the clavicle and thus subject to injury when a fracture occurs. However, late AC degenerative changes can occur and may require excision of the distal clavicular segment. Again, these fractures are treated non-surgically. Type 3 fracture is where there is non-displacement of the fracture but it extends into the acromioclavicular joint. The Allman classification has been further revised by Neer and includes the following: Fractures of the middle third or midshaft fractures are in Group I (the most common), fractures of the distal or lateral third are in Group II, and fractures of the proximal or medial third are in Group III. Because the midshaft of the clavicle is the thinnest segment and does not contain ligamentous attachments, it is the most easily fractured location.įractures of the clavicle are typically described using the Allman classification system, dividing the clavicle into 3 groups based on location. Due to its superficial subcutaneous location and the numerous ligamentous and muscular forces applied to it, the clavicle is easily fractured. The clavicle articulates distally with the acromion at the acromioclavicular joint and articulates proximally with the sternum at the sternoclavicular joint. ![]() The clavicle is an S-shaped bone and is the only osseous link between the upper extremity and the trunk. ![]()
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