Clavicle fractures

All information in this article is summarized from the work "Traumatologie en pratique sportive" (Traumatology in Sports Practice) - Yves Catonné, Frédéric Khiami, Gérard Saillant

Pathophysiology and Classification of Clavicle Fractures

Clavicle fractures are relatively common, accounting for 1.3% of all fractures, with a higher incidence among athletes. Typically, these fractures result from a fall onto the shoulder or an abducted arm, although direct trauma is also frequent.

Often benign, these fractures can be complicated by infections, especially post-surgery, as well as pulmonary (such as pneumothorax) and neurovascular complications. The majority of fractures (75%) affect the diaphysis, while fractures of the extremities are less common.

It is crucial to have a solid understanding of clavicle anatomy to differentiate stable from unstable fractures and to correctly interpret the displacements observed on radiographs.

 

Clinical Presentation

Clinically, the presentation varies depending on the fracture location. The typical patient protects their arm. The examination must include an assessment of the skin to detect any open wounds that could contraindicate immediate surgery. It is also essential to check for the presence of hematomas, edema, or bone protrusion, particularly at the proximal fragment.

 

Imaging

Standard radiography is sufficient to diagnose the type and displacement of the fracture. Targeted views are sometimes necessary to examine fractures at the ends of the bone. For more complex fractures, particularly those of the lateral quarter, a CT scan may be required for a more detailed evaluation, and an ultrasound can be useful to assess ligamentous injuries and confirm fracture instability.

These elements allow for appropriate management of clavicle fractures, from diagnosis to treatment planning, as well as monitoring for potential complications.

Classification of Clavicle Fractures

Type I: fracture lateral to the coracoclavicular ligaments (minimal displacement, no acromioclavicular joint involvement).

Type IIA: fracture medial to the coracoclavicular ligaments.

Type IIB: fracture at the level of the coracoclavicular ligaments.

Type III: fracture extending into the acromioclavicular joint.

Latarjet fracture: 3rd fragment containing the attachment of the coracoclavicular ligaments.

Treatment of Clavicle Fractures

Orthopedic Treatment

Most clavicle fractures are stable and are treated orthopedically. For the medial and middle thirds, immobilization with a sling is often sufficient, especially if the fracture is non-displaced and stable. However, fractures with significant displacement may require a more aggressive approach.

Surgical Techniques

For displaced or unstable fractures, particularly in the outer and middle quarters, the preferred treatment is surgical:

• Plate and screw fixation
• Endobutton fixation

Treatment Indications

The choice between orthopedic or surgical treatment depends on several factors, such as the type and displacement of the fracture. Open fractures, neurovascular complications, and pulmonary injuries generally require surgical intervention.

Results and Return to Sport

Appropriate management of clavicle fractures generally allows for a return to sport within an optimized timeframe. Studies show that the average rate of return to sport is 92% at approximately 14 weeks, with faster consolidation of surgically treated fractures compared to those treated orthopedically.

Complications

Although orthopedic treatment presents few risks of serious complications, displaced fractures not treated surgically can lead to less favorable outcomes. Surgical complications include infection, pain at the implant site, and cases of nonunion.

Conclusion

Clavicle fractures require precise and adapted management. Stable fractures can often be managed successfully conservatively, while displaced fractures benefit from surgical intervention to ensure rapid consolidation and an effective return to normal activity, especially for athletes.