Clavicle Fractures
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Questions and Answers

What is the primary mechanism of displacement of the proximal fracture fragment in a clavicular fracture?

  • Traction from the brachial plexus
  • Gravity pulling the arm downwards
  • Muscle spasms in the surrounding soft tissue
  • Contraction of the sternomastoid muscle (correct)

    • What is the primary reason for assessing the distal neurovascular status in a patient with a clavicular fracture?

  • To assess the severity of the pain and tenderness
  • To rule out any potential nerve or vascular damage (correct)
  • To determine the appropriate surgical approach
  • To evaluate the extent of bone damage

    • What is the purpose of obtaining a 30° caudal radiograph in a patient with a suspected clavicular fracture?

  • To visualize the brachial plexus and subclavian vessels
  • To assess the degree of shortening of the clavicle
  • To evaluate the position and deformity of the fracture (correct)
  • To rule out any potential soft tissue damage

    • Which of the following is a relative indication for surgical management of a clavicular fracture?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of conservative management of a clavicular fracture?

    <p>To promote bone healing and prevent further displacement</p> Signup and view all the answers

    What is the typical location of a clavicular fracture?

    <p>Between the middle and distal thirds of the clavicle</p> Signup and view all the answers

    Study Notes

    Clavicle Fractures

    • Clavicle fractures commonly occur at the midpoint between the middle and distal thirds of the bone.
    • The distal fracture fragment is displaced inferiorly due to gravity, while the sternomastoid muscle displaces the proximal fragment superiorly.
    • Clavicle fractures are more common in young males and are often caused by direct falls onto the shoulder or outstretched hand (FOOSH).

    Presentation

    • Pain and tenderness are present in the shoulder and clavicular region.
    • Visible protrusion along the clavicular line may be seen, and skin tenting or open fracture is possible.
    • It is essential to assess the distal neurovascular status, including the brachial plexus, subclavian vessels, axillary nerve, and artery.

    Investigations

    • Clavicle AP radiograph and 30° caudal are used to assess position and deformity.

    Management

    • Conservative management: Immobilization using a sling or collar and cuff is usually sufficient.
    • Surgical management: Open reduction and internal fixation (screws and plate, intramedullary rods) is indicated for:
      • Displaced lateral fractures
      • Shortening of the clavicle
      • Open fractures
      • Soft tissue (neurovascular) compromise
      • Bilateral fractures
      • Multiple trauma (e.g., flail chest and symptomatic nonunions)

    Complications

    • Postoperative complications:
      • Infection
      • Removal of metalwork
      • Neurovascular injury
    • Malunion (impinged shoulder abduction) or nonunion (~5-10%):
      • Higher rate with lateral fractures
    • Brachial plexus injury (high energy)
    • Pneumothorax (high energy)

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    Description

    This quiz covers the causes, symptoms, and characteristics of clavicular fractures, including the common location of the fracture, displacement of fragments, and visible signs.

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