Clavicle fractures - DRHC Dubai Fracture Clinic

This injury is divided into three parts:

• Clavicle Shaft Fracture 
• Distal Clavicle Physeal Fractures
• Medial Clavicle Physeal Fracture.

Clavicle Shaft Fracture:

• It is a common injury.
• Sometimes it comes as a birth fracture with breech delivery and hard labor.
• The main mechanism is falling onto an outstretched arm or direct trauma to the lateral aspect of the shoulder.
• Rarely, it's accompanied by neurovascular or brachial plexus injury.
• The presentation is pain and inability to move the arm and deformity at the fracture site.

Diagnosis

• X-ray is sufficient to confirm the diagnosis.
• We usually take an anterior-posterior view while tilting the beam 15 cephalic (zanca view).
• The majority of cases can be treated conservatively with sling and observation

We keep surgery for a few cases as shortening in clavicle more than 2 cm in adolescents and neurovascular compromise and displaced fracture with soft tissue at risk from tenting.

Medial Clavicle Physeal Fracture:

It's a rare injury in children which comes from a direct blow on the clavicle or falls onto an outstretched extremity.

Diagnosis

• X-Ray is helpful. The specific view is the serendipity view (tilting the X-Ray beam at 40 degrees toward the patient’s head) and a CT scan is very important in the diagnosis of the displacement.
• The displacement could be anterior which we can feel under the skin or posterior which can endanger the innominate artery and vein, internal jugular vein, phrenic and vagus nerves, trachea, and esophagus.
• Symptoms are pain and inability to move the arm fully. In anterior displacement, symptoms are palpable deformity under the skin, while in posterior displacement, symptoms are dyspnea or dysphagia, tachypnea, stridor, absence of distal pulses, and nerve compression symptoms.
• Treatment is mainly conservative in asymptomatic patients.
• Surgery is either a closed or open reduction with fixation in the posteriorly displaced cases with neurovascular or airway or esophagus compromise.

Distal Clavicle Physeal Fractures:

• It is not common. It counts for about 10% of clavicle fractures. The main cause is a fall onto the side of the shoulder or a direct blow on the lateral part of the clavicle. This childhood fracture is equivalent to Acromioclavicular joint dislocation in adults.
• What really happens with distal clavicle fracture in children is that the lateral physis and periosteal sleeve remain attached to the strong ligaments under the clavicle and the rest of the clavicle displaces away.
• Symptoms are pain and deformity at the lateral side of the clavicle and sometimes ecchymosis.

Diagnosis

• X-Ray with anterior-posterior and axillary lateral and zanca view is helpful.
• Treatment is conservative in the majority of cases even in cases of some displacement as the children have a high ability for fracture remodelling.
• Open reduction is kept only for open fractures and displaced intraarticular fractures and if there is skin or neurovascular compromise.

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