Clavicle Fractures

by / Thursday, 13 June 2019 / Published in Blog, Sports Medicine

Clavicle fractures occur commonly, especially in children and young adults. They constitute 5 to 10% of all fractures. Clavicles are susceptible to injuries due to their superficial location, thin midshaft, and the forces transmitted across it.

The management of clavicle fractures is determined by the location and nature of the injury. Group I (midshaft) fractures occur on the middle third of the clavicle, group II fractures on the lateral (distal) is third, and group III fractures on the medial (proximal) third. Midshaft fractures account for approximately 75 to 80 percent of all clavicle fractures and typically occur in younger persons. Distal third fractures represent about 15 to 25 percent of clavicle fractures. Medial third fractures are least common, accounting for less than 5 percent of clavicle fractures. Midshaft fractures can be treated nonoperatively, and are typically secondary to trauma/fall, but if there is no history, then consider malignancy, rickets, or physical abuse. In most cases, distal fractures are also treated nonoperatively. Surgery is needed for displaced fractures that have a high chance of nonunion. The diagnosis is clinical – based on history and physical examination, confirmed on x-ray imaging, which also guides management.

Surgery is needed for displaced fractures that have a high chance of nonunion

The typical mechanism of injury for clavicle fractures involves a forceful fall with the arm at the side is the most common way to injure one’s clavicle, and it is quite common during contact sports. Rarely, clavicle fractures can occur from a direct blow or from a fall on an outstretched hand.

When there is a clavicle fracture, the patient typically holds the affected arm adducted close to the body, often supporting it with the opposite hand as that tends to limit the pull from the weight of the arm on the fractured bone. Physical examination may reveal bruising, swelling, tenderness, and crepitation on palpation over the clavicle. The defect in the bone may be seen or palpable as well. It is critically important to rule out neurovascular or lung injury. Radiography is performed to confirm the diagnosis and guide management.

There are a few steps that can be taken to prevent clavicle fractures, although they can be quite hard to prevent in general. When playing contact sports, it is important to wear all the recommended protective gear and learn the proper techniques for that sport. It is also important for people of all ages to a well-balanced diet to keep their bones strong, which includes eating lots of vegetables and foods that are rich in calcium and vitamin D. In addition, exercise focused on strength-training and stretching to build strong, flexible muscles. Also, a proper warm-up, such as dynamic stretching exercises, can help muscles perform at their best during play, which can minimize the risk of injury and fractures. Lastly, it is also important to wear well-fitting, supportive footwear that’s right for the sport, which can minimize the risk of injury and fractures.