![]() ![]() Both conservative and surgical treatments were then compared and contrasted. Further literature was gathered regarding the surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. This article first describes the classification of clavicle fractures and then reviews the literature over the past decades to form a conclusion regarding the appropriate management.Ī thorough literature review was performed on assessment of fractures of the clavicle, their classification and the outcomes following conservative treatment. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional outcomes. For the most part, they have been historically treated conservatively with acceptable results. The fractured bone ends are exposed and put back into position using a plate and screws as shown below.Fractures of the clavicle are a common injury and most often occur in younger individuals. The operation is performed with the patient under a general anaesthetic, in other words, completely asleep, and a small 3-4 cm incision is made under the collarbone, at the end of the shoulder. The advantage of fixing them with a plate and screws generally means that you can start to move the arm a lot quicker and to also decrease the incidence of non-union. In my practice, the operation is performed by realigning the bones back to their original position using a plate and screws on top of the bone. Generally all displaced fractures of the distal clavicle require surgery to increase the incidence of union. If there is any evidence clinically and radiologically of displacement, then surgery is generally recommended due to the high incidence of the fracture not healing (non-union). These fractures can then take up to three months to completely heal. If it is undisplaced and there is no obvious lump, the fracture can be treated without surgery and resting the arm in a sling for 4-5 weeks. The management of the distal clavicle fracture really depends on whether it is displaced or undisplaced. In a child this will take about 4 weeks to heal and in an adult about 6 to 8 weeks. It is generally accepted that clavicle fractures in adults that are in good alignment or near anatomical position can be left to heal well in a sling or in a figure-of-8 bandage. This is true for the majority of fractures in patients less than twelve to fourteen years of age however for those older, it is slowly becoming more evident that a lot of these fractures don’t do as well as thought in the past. They have been told that it will take 6 to 8 weeks for the fracture to heal and that you will be left with a lump however it probably won’t bother you in the future. ![]() In the past most patients have been treated in a sling and sent to their general practitioner for ongoing treatment. ![]() How is a diagnosis made?ĭiagnosis of a clavicle fracture is made using the history described by the patient, a plain x-ray of the clavicle and in some instances a CT scan. The shoulder is often painful and a clicking sensation is often felt. This is usually due to the bone displacing upwards and often backwards. There’s generally swelling and bruising and in a lot of cases an obvious deformity or lump on top of the shoulder. One generally feels a crack or acute pain through the outer end of the collarbone. These fractures generally occur due to a fall directly onto the shoulder or a fall onto an outstretched hand. ![]()
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