Clavicle fracture

Q: What is the diagnosis and is this the usual location for this fracture? show answer

A: This is obviously, a left clavicular fracture and yes, this is in the typical location: approximately 75% of all clavicular fractures occur near the junction of the middle and outer third.

Q: What sort of fracture is this? show answer

A: Oblique comminuted fracture.

Q: What is a little atypical in this case? show answer

A: Typically the unopposed action of sternocleidomastoid on the proximal component and the weight of the arm on the distal component result in superior angulation of the fracture on AP view, with the proximal component elevated well above the distal.

Q: How is the oblique view obtained? show answer

A: It is usually achieved by a combination of cephalic angulation of the tube (i.e pointing upwards) ~25 degrees, and can be accentuated by getting the patient to lean back a little.

Q: How are these fractures usually managed? show answer

A: In most instances, non-operative management suffices: immobilisation and a sling or figure-of-8 dressing. In cases where these is significant displacement, angulation, shortening (especially >2 cm) or comminution, internal fixation either with plate-and-screw fixation or with an medullary device (e.g. intramedullary titanium elastic nail) have been shown to result in better cosmetic outcome and higher rates of union. Internal fixation is thus probably advisable in such cases and in patients who are at risk of non-union (e.g. elderly)