Clavicle fractures; clinical pictures, diagnosis, treatment – World Pakistan

Clavicle fractures are common in children and young adults under 25, often caused by hard falls during contact sports. Diagnosis is often made through history and physical examination, but radiography is necessary for treatment options. Most fractures can be managed nonoperatively, but surgery is recommended for high-risk fractures, such as displaced or comminuted ones.

Mechanism of Injury

Clavice fractures are primarily caused by sports and traffic accidents, with cyclists being the most common cause. Other unusual causes include direct impact and indirect trauma from falls. The fracture site and injury method are unrelated.

Clinical picture

Clavicle fractures are common and easily detectable due to their superficial localization. Common clinical signs include pain, shoulder sagging, arm inability to lift, grinding sensation, and deformity. In midshaft fractures, superior displacement of the medial fragment may be due to SCM tension, causing further instability. 10% of all fractures are clavicle fractures, with surgery required depending on comminution, displacement, and shortening. Trauma, falling outward, or medial contact with the clavicle are common causes.

Diagnosis of clavicle fractures

A standard anteroposterior clavicle radiograph is recommended for clavicle injuries, with a 45-degree cephalic tilt view improving evaluation. CT scans may be necessary for less common fractures, and pneumothorax or rib injury should be confirmed. If neurovascular damage is suspected, arteriography, ultrasonography, and CT may be used for treatment. Additional imaging tests may be necessary for proximal clavicular stress fractures.

Complications

Clavicle fractures often result in malunion, which can cause angulation, shortening, or an unfavorable appearance. Most patients have full function, but those with over 2 cm shortening may experience neurological or functional issues.

Nonunion occurs when a fracture doesn’t heal within four to six months, with rates ranging from 6% in middle-third clavicle fractures to 15% in displaced fractures.

Clavicle fractures often cause minor injuries to the brachial plexus or subclavian vessels, and peripheral neuropathy may result from excessive callus production.

Treatment of clavicle fractures

Conservative treatment of clavicle fractures involves immobilization with a sling and rehabilitation, leading to thoracoscapular dyskinesia, prolonged recovery, and suboptimal shoulder function. Conservative care also reduces shoulder function.

Surgical procedures like ORF involve incisions over fracture sites, realigning broken bone fragments, and holding them in place with metal plates and screws until bone healing.Intramedullary fixation stabilizes fractures by inserting a metal rod through the clavicle, while percutaneous fixation uses small metal pins to hold fractures in place, and plate fixation uses screws to hold bone fragments.

Material and methods of research

A study examined 94 patients with clavicle fractures at the Institute of Emergency Medicine’s Department of Traumatology, collecting clinical records, age, gender, trauma etiology, hospital stay, treatment options, and statistical data from January 2019 to December 2023.

Results and discussion

The study reveals that clavicle fractures are most common in individuals aged 26-45 who can work, and their recovery speed is faster. These fractures significantly impact quality of life and self-care for traumatized individuals, especially those from the working class. Short hospital stays can improve patients’ psychological state and reduce surgical costs. The surgical approach to treating clavicle fractures is crucial, as it reduces complications and has a successful track record for difficult fractures.

Conclusion

Clavice fractures are common in traumatology, impacting self-care and self-service. Men (77.7%) are the majority of patients, with quicker healing potentially improving quality of life. 96.8% received ORIF surgery, with lower complications and shorter hospital stays compared to conservative treatment.