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Questions and Answers
What is the typical timeline for early union in clavicle fractures for adults?
What is the typical timeline for early union in clavicle fractures for adults?
In conservative management of an undisplaced clavicle fracture, for how long is immobilization usually recommended?
In conservative management of an undisplaced clavicle fracture, for how long is immobilization usually recommended?
Which of the following is NOT an indication for surgical management of a clavicle fracture?
Which of the following is NOT an indication for surgical management of a clavicle fracture?
What is defined as clinical union in the context of clavicle fractures?
What is defined as clinical union in the context of clavicle fractures?
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At what point in rehabilitation should strengthening exercises typically begin for clavicle fractures?
At what point in rehabilitation should strengthening exercises typically begin for clavicle fractures?
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Which method is typically used for surgical management of a clavicle fracture?
Which method is typically used for surgical management of a clavicle fracture?
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What approach should be taken to maintain proper body mechanics while using a sling?
What approach should be taken to maintain proper body mechanics while using a sling?
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What is the recommended duration for immobilization before clinical union is achieved?
What is the recommended duration for immobilization before clinical union is achieved?
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Which activity should patients be cautious about during the healing phase of a clavicle fracture?
Which activity should patients be cautious about during the healing phase of a clavicle fracture?
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What is the significance of callus formation in clavicle fractures?
What is the significance of callus formation in clavicle fractures?
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What percentage of shoulder fractures do clavicle fractures represent?
What percentage of shoulder fractures do clavicle fractures represent?
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Which of the following groups classifies midshaft clavicle fractures?
Which of the following groups classifies midshaft clavicle fractures?
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What is the primary cause of displacement and shortening in midshaft clavicle fractures?
What is the primary cause of displacement and shortening in midshaft clavicle fractures?
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Which options indicate a common complication associated with clavicle fractures?
Which options indicate a common complication associated with clavicle fractures?
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In what instance might clavicle fractures occur in babies?
In what instance might clavicle fractures occur in babies?
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Which classification includes fractures at the distal third of the clavicle?
Which classification includes fractures at the distal third of the clavicle?
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Which muscle primarily pulls the medial fragment of a midshaft clavicle fracture?
Which muscle primarily pulls the medial fragment of a midshaft clavicle fracture?
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What mechanism of injury is commonly responsible for clavicle fractures?
What mechanism of injury is commonly responsible for clavicle fractures?
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Which of the following is risked during a clavicular fracture from high-velocity trauma?
Which of the following is risked during a clavicular fracture from high-velocity trauma?
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What percentage of clavicle fractures is classified as group III fractures?
What percentage of clavicle fractures is classified as group III fractures?
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Study Notes
Clavicle Fractures
- A clavicle fracture is a common injury occurring in adults and children.
- The clavicle, or collarbone, is the most frequently fractured bone in the shoulder.
- Clavicle fractures are classified into three groups based on their location:
- Group I: Middle third (Midshaft) fractures (80%)
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Group II: Distal third (Lateral-end) fractures (12-15%), commonly associated with non-union
- Neer subclassification: Further categorizes Group II fractures based on the Coracoclavicular ligament's relationship to the fracture fragment
- Group III: Proximal third (Medial-end) fractures (5-6%)
- The increased incidence of shaft fractures is attributed to the proximal and distal ends of the clavicle being strongly secured by ligaments and muscles, making them less vulnerable to trauma.
- In midshaft fractures, displacement and shortening occur due to the combined forces of:
- Sternocleidomastoid muscle pulling the medial fragment superiorly and posteriorly
- Pectoralis major, deltoid muscle, and gravity pulling the lateral fragment inferiorly and anteriorly
Mechanism of Injury
- Direct blow to the shoulder:
- Falls directly onto the lateral shoulder
- Car collisions
- Fall onto an outstretched arm
- Birth canal passage (in babies)
Complications
- Malunion: While common, rarely causes functional impairment
- Non-union: Rare
- Neurovascular involvement: Subclavian vessels and brachial plexus are at risk, especially with high-velocity trauma
- Degenerative arthritis of the acromioclavicular or sternoclavicular joint
Union Time
- Children: Early union occurs in 1-2 weeks
- Adults: Early union occurs in 3-6 weeks, consolidation in 12 weeks
- Callus formation is visible and palpable
Treatment
Conservative Management
- Undisplaced fractures
- Immobilization:
- Sling (2-4 weeks), typically with internal rotation
- Figure-of-eight brace: Used to prevent or reduce fracture shortening during healing
- Treatment duration: Until clinical union is achieved (6-8 weeks), defined by no pain or tenderness at the fracture site
Surgical Treatment
- Indications:
- Displacement or shortening greater than 2 cm
- Severe displacement causing skin tenting (open fracture requiring debridement)
- Associated neurovascular injury requiring intervention
- Non-union (failed conservative treatment)
- Procedures:
- Open reduction and internal fixation with plates and screws
- Intramedullary (IM) fixation
Rehabilitation
- Gradual progression of exercises:
- Gentle motion exercises (pendular) starting at 2-4 weeks
- Gentle ROM exercises at 2-4 weeks, followed by strengthening at 6-10 weeks
- Full activity (including sports) at approximately 3 months, once pain-free motion and radiographic union are confirmed
- Watch body mechanics:
- Maintain proper bone and muscle alignment while using a sling
- Focus on good shoulder position: Avoid shrugging, slouching, or rounding the shoulders
- Cautions for forceful coughing and sneezing:
- Avoid as much as possible
- Consider active-assisted coughing techniques if necessary
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Description
This quiz explores the classification, incidence, and implications of clavicle fractures. It delves into the three groups of fractures based on their locations and highlights the anatomy involved in these common injuries. Perfect for students in medical or healthcare fields looking to enhance their understanding of orthopedic injuries.
