Wheeless' Textbook of Orthopaedics
C.R. Wheeless MD
Wheeless' Textbook of Orthopaedics
- See:
- Clavicular Frx in Children:
- Congential Pseudoarthrosis of Clavicle:
- Distal Clavicle Excision:
- AC joint
- Scapula Fracture:
- Sternoclavicular Joint Injury:
- Serendipity View
- Discussion:
- serves as protector of brachial plexus
- acts as a strut which provides th only bony connection between upper limb and the thorax.
- embryology:
- first bone to ossify
- undergoes intra-membranous ossification w/o going thru prior enchondral stage;
- later in adolescence, secondary enchondral ossification does occur at both its ends;
- in adolescents, usually a single ossification center develops at medial end of the
clavicle, fusing with the shaft by age 25;
- occassionally, an ossification center may develop at the acromion process (os acromiale),
in which case it units with the shaft immediately;
- these should not be mistaken for fractures;
- references:
- The embryology of the clavicle.
Gardner E: Clin Orthop 1968;58:9.
- Reflections upon the aetiology of congenital pseudarthrosis of the clavicle.
Lloyd-Roberts GC, Apley AG, Owen R: J Bone Joint Surg 1975;57B:24.
- Radiology:
- Serendipity View:
- best visualized w/ AP view & view w/ beam angled 30 deg. cephalad;
- w/ frx of clavicle, distal fragment & arm tend to sag, while proximal fragment,
held by the sternoclavicular joint tends to point upward;
- in any clavicular frx, carefully scutinize x-rays for presence of scapular frx,
which represents a floating shoulder;
- Classification:
- Frx of Middle 1/3 (Group I):
- most common clavicular frx in both adults and children (80%);
- frx usually occur in mid third region & tend to have upward displacement
of medial frag produced by sternocleidomastoid muscle.
- lateral fragment is pulled downward by wt of limb;
- Frx of Distal 1/3 (Group II)
- account for 10-15% of clavicle frx;
- frx is medial to the CC ligament insertion;
- Minimal displacement (Type I)
- Frx Medial to CC Ligaments (Type II)
- Articular Surface Fractures (Type III)
- Frx of Medial 1/3 (Group III):
- account for 5% of clavicular frx;
- Non Operative Treatment:
- it is difficult to reduce and maintain the reduction of clavicle fractures;
- only indicated if skin is comprimised or if fracture has impaled trapezius;
- union usually occurs rapidly & produces prominent callus;
- despite deformity, healing usually proceeds rapidly;
- references:
Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling.
Recovery following fractures of the clavicle treated conservatively.
- Operative Treatment:
- Intra-medullary Clavicular Fixation:
- references:
- Non-union of fractures of the mid-shaft of the clavicle. Treatment with a
modified Hagie intramedullary pin and autogenous bone-grafting.
- plate fixation:
- references:
Open reduction and internal fixation of ipsilateral fractures of the
scapular neck and clavicle
Open reduction and internal fixation of clavicular fractures.
Low-contact dynamic compression plating of the clavicle.
Fractures of the distal clavicle: a case for fixation.
Osteosynthesis of irreducible fractures of the clavicle with 2.7-MM ASIF plates.
Plating of fresh clavicular fractures: results of 122 operations.
- Floating Shoulder:
- multiple authors have reported excellent results with healing rates
greater than 99% for variety of immobilization techniques;
- incidence of nonunion, malunion, NV complications total < 1%;
- single disruptions of SSSC have uniformly good results with nonoperative treatment;
- double disruptions of SSSC are a combination of innocuous injuries which
create instability for UE best surgically treated
- ORIF simpler fracture reduces other injury satisfactorily
- Non Union of the Clavicle:
- defined as absence of radiographic healing by 4 months;
- occurs most often in the central third where the clavicle lacks abundant muscular coverage;
- in the mid-clavicular region, deforming forces include the pectoralis major (pulls the distal
fragment inferiorly and medially) and the sternocleidmastoid (which is pulled superiorly);
- exam:
- note function of brachial plexus (esp lower trunk);
- r/o presence of thoracic outlet syndrome;
- management: intra-medullary clavicular fixation:
- references:
Nonunion of the clavicle and thoracic outlet syndrome.
Non-union of fractures of the mid-shaft of the clavicle. Treatment with a
modified Hagie intramedullary pin and autogenous bone-grafting.
Non-union of the clavicle. Associated complications and surgical management.
The operative treatment of mid-shaft clavicular non-unions.
Surgery for ununited clavicular fracture.
The treatment of nonunion fractures of the midshaft of the clavicle with
an intramedullary Hagie pin and autogenous bone graft.
Boehme D. Curtis RJ Jr. DeHaan JT. Kay SP. Young DC. Rockwood CA Jr.
Instructional Course Lectures. [JC:ifc 42:283-90, 1993.
Condensing osteitis of the clavicle. A review of the literature and report of three cases.
Current concepts in the treatment of fractures of the clavicle.
Osteolysis of the distal part of the clavicle in male athletes.
Injuries to the clavicle and acromioclavicular joint. x
Atlanto-axial rotatory fixation and fracture of the clavicle. An association and a classification.
Outcome of clavicular fracture in 89 patients.
The mechanism of clavicular fracture. A clinical and biomechanical analysis.
Transcutaneous reduction and external fixation of displaced fractures of
the proximal humerus. A controlled clinical trial.
- See:
- Clavicular Frx in Children:
- Congential Pseudoarthrosis of Clavicle:
- Distal Clavicle Excision:
- AC joint
- Scapula Fracture:
- Sternoclavicular Joint Injury:
- Serendipity View
- Discussion:
- serves as protector of brachial plexus
- acts as a strut which provides th only bony connection between upper limb and the thorax.
- embryology:
- first bone to ossify
- undergoes intra-membranous ossification w/o going thru prior enchondral stage;
- later in adolescence, secondary enchondral ossification does occur at both its ends;
- in adolescents, usually a single ossification center develops at medial end of the
clavicle, fusing with the shaft by age 25;
- occassionally, an ossification center may develop at the acromion process (os acromiale),
in which case it units with the shaft immediately;
- these should not be mistaken for fractures;
- references:
- The embryology of the clavicle.
Gardner E: Clin Orthop 1968;58:9.
- Reflections upon the aetiology of congenital pseudarthrosis of the clavicle.
Lloyd-Roberts GC, Apley AG, Owen R: J Bone Joint Surg 1975;57B:24.
- Radiology:
- Serendipity View:
- best visualized w/ AP view & view w/ beam angled 30 deg. cephalad;
- w/ frx of clavicle, distal fragment & arm tend to sag, while proximal fragment,
held by the sternoclavicular joint tends to point upward;
- in any clavicular frx, carefully scutinize x-rays for presence of scapular frx,
which represents a floating shoulder;
- Classification:
- Frx of Middle 1/3 (Group I):
- most common clavicular frx in both adults and children (80%);
- frx usually occur in mid third region & tend to have upward displacement
of medial frag produced by sternocleidomastoid muscle.
- lateral fragment is pulled downward by wt of limb;
- Frx of Distal 1/3 (Group II)
- account for 10-15% of clavicle frx;
- frx is medial to the CC ligament insertion;
- Minimal displacement (Type I)
- Frx Medial to CC Ligaments (Type II)
- Articular Surface Fractures (Type III)
- Frx of Medial 1/3 (Group III):
- account for 5% of clavicular frx;
- Non Operative Treatment:
- it is difficult to reduce and maintain the reduction of clavicle fractures;
- only indicated if skin is comprimised or if fracture has impaled trapezius;
- union usually occurs rapidly & produces prominent callus;
- despite deformity, healing usually proceeds rapidly;
- references:
Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling.
Recovery following fractures of the clavicle treated conservatively.
- Operative Treatment:
- Intra-medullary Clavicular Fixation:
- references:
- Non-union of fractures of the mid-shaft of the clavicle. Treatment with a
modified Hagie intramedullary pin and autogenous bone-grafting.
- plate fixation:
- references:
Open reduction and internal fixation of ipsilateral fractures of the
scapular neck and clavicle
Open reduction and internal fixation of clavicular fractures.
Low-contact dynamic compression plating of the clavicle.
Fractures of the distal clavicle: a case for fixation.
Osteosynthesis of irreducible fractures of the clavicle with 2.7-MM ASIF plates.
Plating of fresh clavicular fractures: results of 122 operations.
- Floating Shoulder:
- multiple authors have reported excellent results with healing rates
greater than 99% for variety of immobilization techniques;
- incidence of nonunion, malunion, NV complications total < 1%;
- single disruptions of SSSC have uniformly good results with nonoperative treatment;
- double disruptions of SSSC are a combination of innocuous injuries which
create instability for UE best surgically treated
- ORIF simpler fracture reduces other injury satisfactorily
- Non Union of the Clavicle:
- defined as absence of radiographic healing by 4 months;
- occurs most often in the central third where the clavicle lacks abundant muscular coverage;
- in the mid-clavicular region, deforming forces include the pectoralis major (pulls the distal
fragment inferiorly and medially) and the sternocleidmastoid (which is pulled superiorly);
- exam:
- note function of brachial plexus (esp lower trunk);
- r/o presence of thoracic outlet syndrome;
- management: intra-medullary clavicular fixation:
- references:
Nonunion of the clavicle and thoracic outlet syndrome.
Non-union of fractures of the mid-shaft of the clavicle. Treatment with a
modified Hagie intramedullary pin and autogenous bone-grafting.
Non-union of the clavicle. Associated complications and surgical management.
The operative treatment of mid-shaft clavicular non-unions.
Surgery for ununited clavicular fracture.
The treatment of nonunion fractures of the midshaft of the clavicle with
an intramedullary Hagie pin and autogenous bone graft.
Boehme D. Curtis RJ Jr. DeHaan JT. Kay SP. Young DC. Rockwood CA Jr.
Instructional Course Lectures. [JC:ifc 42:283-90, 1993.
Condensing osteitis of the clavicle. A review of the literature and report of three cases.
Current concepts in the treatment of fractures of the clavicle.
Osteolysis of the distal part of the clavicle in male athletes.
Injuries to the clavicle and acromioclavicular joint. x
Atlanto-axial rotatory fixation and fracture of the clavicle. An association and a classification.
Outcome of clavicular fracture in 89 patients.
The mechanism of clavicular fracture. A clinical and biomechanical analysis.
Transcutaneous reduction and external fixation of displaced fractures of
the proximal humerus. A controlled clinical trial.