Clavicle Fractures: Epidemiology, Anatomy, and Treatment Options

Epidemiology of Clavicle Fractures

Clavicle fractures account for about 2.6% of all fractures and for 44% to 66% of fractures around the shoulder. They are more common in young males and elderly females.

Most clavicle fractures occur in the middle third of the bone, which is the weakest part. This accounts for 80% of all clavicle fractures. The lateral third (near the shoulder) and the medial third (near the chest) account for 15% and 5%, respectively.

The most common cause of clavicle fractures is falling onto the affected shoulder, which creates a bending force on the bone. This accounts for 87% of clavicle fractures. Other causes include direct impact (7%) and falling onto an outstretched hand (6%).

Clavicle fractures can also occur due to muscle contractions during seizures, pathologic bone conditions, or stress fractures. However, these are rare causes.

Anatomy of the Clavicle

The clavicle is an S-shaped bone that has a convex curve at the medial end (near the chest) and a concave curve at the lateral end (near the shoulder). It is widest at the medial end and thins laterally.

The clavicle is the first bone to form in the fetus (fifth week of gestation) and the last one to fuse in adulthood (22 to 25 years of age). It has two flat ends that are connected by a tubular middle, which has little medullary bone.

The clavicle functions as a strut that supports the shoulder from the trunk and allows it to move freely. It also protects the vital structures that lie behind it, such as the brachial plexus (a network of nerves), the subclavian and axillary vessels (blood vessels), and the superior lung.

The medial third of the clavicle is strong in axial load (force along its length) and is attached to the sternum (breastbone) by ligaments. The lateral third of the clavicle is weaker in axial load and is attached to the acromion (part of the shoulder blade) by ligaments. The junction between the two parts is where most clavicle fractures occur.

The distal clavicle contains two important ligaments that stabilize the acromioclavicular (AC) joint: the trapezoid and conoid ligaments. These are collectively called the coracoclavicular ligaments. They are stronger than the AC ligaments and prevent vertical displacement of the clavicle.

Treatment Options for Clavicle Fractures

The treatment of clavicle fractures depends on several factors, such as:

• The location and type of fracture
• The degree of displacement and angulation
• The presence of associated injuries or complications
• The patient’s age, activity level, and preferences

In general, most clavicle fractures can be treated conservatively with a sling or a figure-of-eight bandage to immobilize the arm and allow natural healing. This usually takes about 6 to 8 weeks for adults and 3 to 4 weeks for children .

Some clavicle fractures may require surgical intervention, especially if they are:

• Open (the skin is broken)
• Comminuted (the bone is shattered into many pieces)
• Displaced more than 2 cm or angulated more than 20 degrees
• Associated with neurovascular injury or pneumothorax (collapsed lung)
• Affecting the AC joint or causing shoulder instability
• Causing cosmetic deformity or functional impairment

Surgical treatment involves reducing (aligning) and fixing (stabilizing) the fracture with plates, screws, wires, pins, or rods. This can improve pain relief, healing time, cosmetic appearance, and shoulder function .

The choice of treatment for clavicle fractures should be individualized based on a careful evaluation of each case. The potential benefits and risks of each option should be discussed with the patient before making a decision.

How long does it take to recover from a clavicle fracture?

Conclusion

Clavicle fractures are common injuries that can affect anyone at any age. They can be caused by various mechanisms, such as falls, impacts, or seizures. They can involve different parts of the clavicle, which has a complex anatomy and function. They can be treated with either conservative or surgical methods, depending on the severity and type of fracture. The goal of treatment is to restore the normal anatomy and function of the clavicle and the shoulder.

If you have any questions or concerns about clavicle fractures, please consult your doctor or a qualified orthopedic surgeon. They can provide you with more information and guidance on how to manage your condition.

Clavicle fractures are a common injury, accounting for up to 66% of shoulder fractures and 2.6% of all fractures. Middle third fractures are the most common and are strongest in axial load. Falls onto the affected shoulder are the most common cause. A careful clinical evaluation is essential to assess neural and vascular integrity, while radiographic evaluation involves standard anteroposterior radiographs or imaging for minimally displaced fractures. Clavicle fractures can be classified according to anatomic description or using the Allman or Orthopaedic Trauma Association classification systems. Nonoperative treatment involves immobilization for 4-6 weeks with some deformity usually resulting. Operative treatment may be necessary for open fractures, associated neurovascular compromise, and skin tenting with potential for progression to open fracture. Complications of clavicle fractures include neurovascular compromise, malunion, nonunion, and posttraumatic arthritis.

Clavicle Fractures: Epidemiology, Anatomy, and Treatment Options