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Clavicle Fractures

The best care

The clavicle is the primary protector of the brachial plexus, which is a large group of nerves that exit the neck and enter the upper extremity and travel down through the arm with specific pathways all the way to the tips of the fingers.  These nerves provide both sensation and feeling as well as muscle stimulation for motion, movement and strength.  The primary function of the clavicle is to provide a strut, by which a bony connection between the upper limb and the thorax (or the chest.)  As a child, this is usually the first bone to ossify in the body and can be separated into three distinct parts. The first is the inner third toward the chest wall, then the middle third and the outer third, with respect to the injuries which occur, which are most frequently fractures. There are several important ligamentous structures which attach to the clavicle to provide bone and shoulder stability.  Both with and without fractures, it is sometimes necessary to repair these.  The coracoclavicular ligaments attach the scapula (or wing blade) to the clavicle lie in close proximity to the acromioclavicular joint. Clavicle fractures can be treated both operatively with either plates and screws or with intermedullary pins (pins which are placed through the center of the bone such as realigning two broken ends of a straw with an inner dowel.)  These implants can be strategically placed to reduce the fracture and with or without bone grafting (or bone supplementation,) producing a healing bone which is of the appropriate length, rotation and angulation.   For the most part, non operative treatment of these fractures or conservative treatment is the option.  Operative indications for surgery are gross displacement of the fracture with or without tinting of the skin (i.e., potential for the bone to poke through the skin as it becomes irritated and ulcerates,) as well as open fractures or fractures with impending possible open components.  Fractures with significant displacement that causes shorteningof the shoulder and significant comminution (i.e., many small pieces) are amenable to fixation. Injuries to other structures such as the subclavian artery, the brachial plexus or a floating shoulder, which is a loss of the majority of the shoulder connections between sub-joints (scapulothoracic, glenohumeral, acromioclavicular and sternoclavicular.)  Please note that the diagnosis of a clavicle fracture and the ensuing treatment, whether conservative or operative, must take into account the patients physiologic and chronologic age, as well as the biological zone of injury (the area where the fracture and the associated soft tissue trauma occurred) and the type of fracture and associated injuries.   Most importantly, consideration for the patient’s activity status at work and lifestyle are important in the treatment plan. Each plan of care will be individualized and you and your physician should explore all options and decide on the best plan for that specific injury.

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