Classification of Distal Clavicle Fractures and Indications for Conservative Treatment.

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Abstract

[Indexed for MEDLINE] 5. Orthop Traumatol Surg Res. 2017 Feb;103(1S):S53-S59. doi: 10.1016/j.otsr.2016.11.007. Epub 2016 Dec 30. Clavicle fractures. Ropars M(1), Thomazeau H(2), Huten D(2). Author information: (1)Service de chirurgie orthopédique, CHU de Rennes, Pontchaillou University Hospital, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex, France. Electronic address: mickael.ropars@chu-rennes.fr. (2)Service de chirurgie orthopédique, CHU de Rennes, Pontchaillou University Hospital, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex, France. Management of clavicle fracture has progressed over the last decade, notably with wider use of surgery in midshaft fracture, and new techniques for lateral fracture. Midshaft clavicle fracture treatment needs to be personalized and adapted to the patient's activity level. Whichever the segment involved, treatment for non-displaced fracture is functional; elbow-to-body sling immobilization seems the best tolerated. Apart from regular surgical indications (shoulder impaction, floating shoulder, open fracture or fracture with neurovascular complications), surgery is recommended in case of bone shortening exceeding 1.5cm in young active patients. The technique needs to take account of clavicle anatomy: notably periosteal vascularization in midshaft fracture and acromioclavicular ligament integrity and location in case of lateral fracture. Plate osteosynthesis should take account of bone diameter and 3D curvature; intramedullary fixation should take account of intramedullary canal morphology. Although iatrogenic vascular complications are rare, vessel relations and variants need to be known, especially in the medial end of the clavicle and midshaft. Lateral segment fractures are a particular entity. Large-scale randomized studies are needed to assess indications and results for the various possible internal fixation techniques: isolated or associated to ligament reconstruction, rigid or flexible, and open or arthroscopic. Copyright © 2016 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2016.11.007