Treatment of Clavicle Fractures and Malunions
William N. Levine, Guido Marra in Fractures of the Shoulder Girdle, 2003
The clavicle is a truly eloquent bone. It has a unique shape and is the only long bone in the body to form via intramembranous ossification. It is the first bone to ossify and the last to stop growing. It is the only diarthrodial link between the upper extremity and the rest of the axial skeleton. Even Codman noted that ‘‘it seems to me that the clavicle is one of man’s greatest skeletal inheritances’’ in that it sets us off from other animals. It is the most commonly fractured bone in childhood and accounts for about 15% of all fractures and 44% of upper extremity fractures.
Clavicle – Infero-Superior
A Stewart Whitley, Charles Sloane, Gail Jefferson, Ken Holmes, Craig Anderson in Clark's Pocket Handbook for Radiographers, 2016
Fig. 2.20a Positioning for infero-superior clavicle projection. The patient sits facing the X-ray tube, resting against the image receptor. Some receptor supports allow forward angulation of the cassette of 15 degrees towards the shoulder. This reduces the distortion caused by the cranially projected central beam. The unaffected shoulder is raised slightly to bring the scapula in contact with the receptor. The patient’s head is turned away from the affected side. The image receptor is displaced above the shoulder to allow the clavicle to be projected into the middle of the image.
Shoulder, Scapula, and Clavicle Radiography
Russell L. Wilson in Chiropractic Radiography and Quality Assurance Handbook, 2020
The shoulder and scapula can be radiographically evaluated at the same time. Therefore, a study to rule out fracture of the shoulder may not demonstrate clavicle or acromioclavicular joint pathology as well as dedicated views. All views of the clavicle or shoulder should be taken erect; this will provide some weight-bearing effect and generally less discomfort for the patient. The patient should be turned toward the shoulder of interest until the scapula is parallel to the film. The external rotation shoulder views should have the humerus epicondyle parallel to the film. The internal rotation view will have the epicondyle perpendicular to the film, or the humerus in a lateral position. The internal and external rotation views are routinely taken on nontraumatic injury shoulder studies.
The early development and ossification of the human clavicle—an embryologic study
Published in Acta Orthopaedica Scandinavica, 1990
Satoshi Ogata, Hans K. Uhthoff
Morphologic studies of the early development of the clavicle were carried out in 46 human embryos and fetuses ranging in age from 6 to 12 weeks. We confirmed that the clavicle is formed by two membranous primary ossification centers appearing by 6 weeks and fusing approximately 1 week later. Cartilage at both ends of the clavicle then develops. In time, the medial cartilaginous mass contributes more to the growth in length of the clavicle than the lateral cartilaginous mass. The spatial orientation of both ossification centers and the development of enchondral bone formation at the ends of the clavicle lead to its characteristic shape. Interestingly, the primary ossification centers contribute little to the growth in length. The junction of the two centers of ossification is situated between the lateral and middle third of the clavicle and, consequently, does not correspond to the site of congenital pseudarthrosis, which is located in the middle part of the clavicle.
Neonatal clavicle fracture in cesarean delivery: incidence and risk factors
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2017
Hyun Ah Choi, Yeon Kyung Lee, Sun Young Ko, Son Moon Shin
Background: Neonatal clavicle fracture in cesarean delivery is rare and has not been extensively studied. Methods: We performed a retrospective review of cesarean deliveries with neonatal clavicle fracture during a 12-year period. Maternal and neonatal factors as well as surgical factors related to cesarean delivery for the fracture were determined and compared to the control group to analyze their significance. Results: Among a total 89 367 deliveries during the study period, 36 286 babies were born via cesarean section. Nineteen cases of clavicle fractures in cesarean section were identified (0.05% of total live births via cesarean section). In the analysis of maternal and neonatal risk factors, birthweight, birthweight ≥ 4000 g and maternal age were significantly associated with clavicle fracture in cesarean section. However, clavicle fractures were not correlated with the selected surgical factors such as indication for cesarean section, skin incision to delivery time and incision type of skin and uterus. Logistic regression analysis showed that birthweight was the major risk factor for clavicle fracture. Conclusion: Clavicle fractures complicated 0.05% of cesarean deliveries. The main risk factor related to a clavicle fracture in cesarean section was the birthweight of an infant. As reported in previous studies associated with vaginal delivery, clavicle fracture is considered to be an unavoidable event and may not be eliminated, even in cesarean delivery.
Surgical treatment, complications, and reimbursement among patients with clavicle fracture and acromioclavicular dislocations: a US retrospective claims database analysis
Published in Journal of Medical Economics, 2019
Matthew Putnam, Mollie Vanderkarr, Piyush Nandwani, Chantal E. Holy, Abhishek S. Chitnis
Aims: To assess rates of surgical treatment, post-surgical complications, reoperations, and reimbursement in patients with clavicle fractures and acromioclavicular (AC) dislocations. Materials and methods: This US retrospective study used data from patients with ≥1 diagnosis of clavicle fracture or AC dislocation (index) between 2012–2016. Surgical treatment was defined as a procedure within 4 weeks after clavicle fracture/AC dislocation. Rates of complications (infection, non-union, mal-union), reoperations (device removal or revisions), and all-cause healthcare reimbursement (adjusted to 2016$) were evaluated 2 years post-index among surgical patients. Results: A total of 95,243 patients with clavicle fracture and 52,100 patients with AC dislocation were identified. Mean (SD) age for clavicle fracture and AC dislocation was 23.8 (18.6) and 33.0 (15.6) years, respectively. Most clavicle fracture and AC dislocation patients were male (70.9% and 78.0%, respectively), and had few comorbidities (86.4% and 84.8% had a Charlson Comorbidity Index = 0 and 73.1% and 66.0% had Elixhauser = 0, respectively). Only 15.2% of clavicle fracture and 5.3% of AC dislocation patients received surgical treatment. Among patients undergoing surgical treatment, 2-year rates of infection, non-union, and mal-union were 1.0%, 4.2%, and 0.9%, respectively, for clavicle fracture, and 2.0%, 0.9%, and 0.1%, respectively, for AC dislocation. Reoperations occurred in 83.0% of clavicle fracture and 67.5% of AC dislocation patients. Mean (SD) 2-year reimbursement was $27,635 ($68,173) for clavicle fracture and $23,096 ($28,746) for AC dislocation. Limitations: Administrative claims data lack clinical information, limiting inferences that can be made. This data may not be generalizable to other patients. Conclusions: Rates of surgical treatment for clavicle fractures and AC dislocation and rates of infection, non-union, and mal-union among surgically-treated patients were low. However, surgical patients had high rates of device removal or revision surgery during 2-year follow-up. Improved surgical methods and technologies could reduce non-planned reoperations and device removals, thereby reducing healthcare system costs.
Related Knowledge Centers
- Scapula
- Shoulder
- Upper Limb
- Anatomy
- Long Bone
- Pectoral Girdle