1. CLAVICLE FRACTURE
HARSHITA YADAV
M.P.T (ORTHO)

2. CLAVICLE OSTEOLOGY

3. PECULARITIES OF CLAVICLE
Name derived from latin word – clavis & clavicula
( musical symbol)
Synonyms - Collar bone; beauty bone
Most superficial bone
Only long bone which lies horizontal in the body

6. MUSCLE ATTACHMENTS

8. PLATYSMA (Shaving muscle)
1. Variable in terms of
thickness& extend
2. Usually envelopes the
anterior & superior
aspects of clavicle
3. Runs in subcutaneous
tissue
4. Extending
to
mandible & deeper
fascial muscle
5. Divided
during
surgical approach

10. LIGAMENTS

11. NEUROVASCULAR BUNDLE AROUND CLAVICLE

12. OSSIFICATION
1. 1st bone to ossify
2. Two Primary centers appears in the shaft during 6th wk of
fetal life and soon fuses with each other.
3. The sternal end ossifies from a secondary centre that
appears between 15 & 20 yrs of age , & fuses with shaft by
the age of 25 years.
4. An addinal center may appear in the acromian.
5. It is the only long bone to ossify by the intramembranous
ossification.

13. FUNCTION OF CLAVICLE
• Serves as bony link from thorax to shoulder.
• Stable linkage for shoulder movements &
contibutes significantly to power & stability of
shoulder girdle.
• Protective
structure
cover
to
vital
neurovascular
• Also contributes to respiratory movements

15.  Pathological #
Stress #

17. CLASSIFICATION :
ON THE BASIS OF THEIR LOCATION

19. Rockwood classification :
Type 2 -

20. Grp-1 fall on outstretched hand
Grp-2 fall on lateral shoulder
Grp-3 due to indirect force applied on lateral shoulder

21. Robinson classification

22. CLINICAL
FEATURES
Pain
Swelling
Subcutaneus
lump
Tenderness

24. IMAGING
1.
A-P View
Radiographic beam should
be angled 20 degrees
superiorly to eliminate the
overlap of thoracic cage

25. 2. Zanca view
* A 10 -15 degree cephalic tilt of standard view of A-C
joint .
*
Helps to delineate the fracture well, by removing the
overlap
of upper portion of thoracic cage.

26. A-P view
Zanca view

27. 3. CT scan
* Mid shaft fracture – rarely done
* Helpful in evaluating fractures of medial third of
clavicle
Medial clavicular, Comminuted , intra – articular fracture

28. Type 1 clavicular fracture( middle fracture)

29. Type 1 comminuted clavicular fracture with skin tenting

30. Type 2 clavicular fracture (lateral third)

31. Type 3 clavicular fracture (medial fracture)

32. Distal clavicular fracture
Type 1
Type 2

33. ASSOCIATED INJURIES
1 . Vascular injuries requiring repair
2 . Progressive neurological deficit
3. Ipsilateral upper exterimity injuries
4. Multiple ipsilateral upper rib fracture
5. “Floating shoulder”
6. Bilateral clavicle fracture

36. TREATMENT

37. Non – operative treatment
 In children , the fracture is undisplaced and hence , a cuff
and collar sling with strapping over the fracture site with
elastoplast is adequate.
 These are removed after 2 weeks and exercises of the
shoulder are advised .
 Stiffness of joint is unusual in children . It always unites in
children.

38.  In adults , the undisplaced fracture is treated with
traingular sling which supports the upper limb , with active
exercises of fingers , wrist and elbow ( 50 times , thrice a
day). The sling is removed after 3 weeks and shoulder
exercises is advised .
 If the fracture fragments are displaced, the distal
fragment is lifted upwards and pulled backwards and
figure of 8 bandage is applied with gud padding of both
axilla with cotton .
 Periodic check ups are important to look pressure sores in
the axillary folds by figure of 8 bandage.

39.  In elderly, the displacements are ignored and treated with
traingular sling for 3 weeks followed by active exercises of
the shoulder.
 The elbow , wrist and fingers sholuld be exercised from
day one of injury

41. Operative treatment
 Indications for open reduction :
 Open #








Neurovascular injuries
Symptomatic non-unioun
Soft tissue interposition
Clavicle # associated with glenoid / scapular neck #
# of the distal third with ligament
Rupture
Polytraumatized patient
Non- union

43. Advantages





Smaller, more cosmetic skin incision
Less soft tissue stripping at the fracture site
Decrease hardware prominance following fixation
Technically, straightforward hardware removal &
A possibly lower incidence of refracture or fracture at the
end of the implant
 A small incision may be necessary to reduce vertically
oriented communited fragments & “ tease” then back into
alingment.

44. Partially threaded screws
Cannulated screws
smooth screws

45. Use of precontoured
plate for displaced
Mid Shaft # of
clavicle

46. Cerclage wires in isolation is inaequate to control the
deforming forces at the site of a displaced clavicle fracture. It
results in all of the risks of surgical intervention with few of
benifts and is so avoided.

47. For sagittal plane obliquity or fracture comminution, AP
lag screws are used with a superior plate placed in
neutralization mode.

48. Lag screw
Anatomical plate

50.  Post- operative protocol
 The arm is placed in standard sling for comfort & gentle
pendulum exercises are allowed, & the patient is seen the
# clinic at 10- 14 days postoperatively.
 The wound is checked and radiographs are taken.
 The sling is discontinued & unrestricted ROM
exercises are allowed, but no strengthening, resisted
exercises or sports activities are allowed .
 At 6 wks postoperatively, radiographs are taken to
ensure bony union. If acceptable , the patient is allowed
to begin resisted & strengthening activites.
 If delayed union is evident, then more aggressive activites
are avoided.
 It is generally advised that contact & / unpredictable
sports should be avoided for 12 wks postoperatively.

51. Plate Or Hook
Plate
Fixation
Of Displaced #
Of
Lateral
clavicle

52. • The # site is reduced, & it may be held with either
k-wire or a lag screw.
• If the main # is in coronal plane, it may be possible to lag
the # from anterior to posterior through a stab incision
separate from the primary incision. Once the fracture is
reduced & provisionally stabilized, the optimal type is
chosen.
• Anatomical plate, fully threaded cancellous screws .

53. K -wire

55. Fully threaded,
cancellous screw

56.  Post- operative protocol
 The arm is placed in standard sling for comfort & gentle
pendulum exercises are allowed, & the patient is seen the
# clinic at 10- 14 days postoperatively.
 The wound is checked and radiographs are taken.
 The sling is discontinued & unrestricted ROM
exercises are allowed, but no strengthening, resisted
exercises or sports activities are allowed .
 At 6 wks postoperatively, radiographs are taken to
ensure bony union. If acceptable , the patient is allowed
to begin resisted & strengthening activites.
 If delayed union is evident, then more aggressive activites
are avoided.
 It is generally advised that contact & / unpredictable
sports should be avoided for 12 wks postoperatively.

57. Dynamic compression plate(DCP)
 External fixation may be a method of choice

58. COMPLICATIONS

59.  Infection
 Non-union (rare)
 Mal-union (common)
 Neurovascular injury
 Acute injuries (scapulothoracic dissociation)
 Delayed injuries (TOS)
 Iatrogenic injury
 Refracture
 Scapular winging