Injuries of Clavicular Complex

Brief Review:

  1. Clavicular fractures

    • Most fractures involve the midshaft (80%)
    • Most clavicle fractures can be definitively treated nonsurgically with a sling or a figure-8 dressing
      • Indications for surgery: Significant displacement (>100%), any tenting of the skin, significant comminution, or excessive shortening (>2 cm)
    • Distal clavicle fractures have a higher rate of nonunion with nonsurgical treatment.
  2. Acromioclavicular joint

    • Grade 1 and grade 2 injuries have an excellent prognosis with conservative treatment
    • Treatment of grade 3 AC injuries is controversial
    • Grade 4 injuries are frequently missed on routine AP radiographs, easily identified in routine axillary shoulder views.
    • Grade 5 injuries: equivalent to severe grade 3 injuries (300% translation)
    • Grade 6 AC injuries: extremely rare
  3. Sternoclavicular Complex

    • Acute SC joint dislocations:
      • identified clinically with localized tenderness over the medial clavicular aspect, and gross deformity may be present.
      • The examination should always include an assessment of the patient’s airway and circulation, including cervical (jugular) venous
    • Because of overlapping shadows, these studies may be difficult to interpret.
      • When suspicious, the best test is computed tomography
    • Anterior Dislocation
      • Anterior dislocations tend to be unstable (redisplace after attempted reduction)
      • Fortunately usually heal uneventfully, leaving an asymptomatic medial prominence and occasional popping, with minimal effect on the patient’s activities of daily living (ADLs)
    • Posterior Disclocation
      • Dangerous because of proximity to the great vessels posteriorly
    • Important considerations: Age of the patient and normal maturation of the proximal epiphysis.
      • The medial clavicle epiphysis is one of the last to appear (at 19 to 23 years of age) and then the last to fuse (at 23 to 25 years of age)
      • In patients younger than 23 years of age, these injuries are generally physeal injuries and not true dislocations, reducing the need for aggressive treatment