Mechanism of Injury and Treatment of Clavicle Fracture:

A damaged collarbone is also known as a clavicle-fracture. This is a very typical crack that happens in individuals of all age groups.

Functions of Clavicle

• It increases the arm strength mechanism.
• It protects the neurovascular bundle consisting of subclavian vessels and brachial plexus.
• It gives attachments to important muscles around the shoulder.
• It braces the shoulder back during rest and motion (Strut function).

Mechanism of Injury

Direct

Due to fall on the point of the shoulder. This is the most common mode of injury accounting for 91 percent of the cases.

Direct Trauma

Direct trauma over the clavicle due to RTA, direct injury, etc. accounts for 8 percent of the cases.
Indirect fall on the outstretched hands accounts for 1 percent of cases.

Sites of Fracture

• Eighty-five percent of the fracture clavicle occurs at the junction of middle and outer third.
• One percent at the medial end of the clavicle (5%).
• Lateral end fracture is uncommon (About 10%) (Distal 1/3rd).

Classification of Fracture Clavicle

1.    Group I: It is fractures involving middle one-third of the shaft.
2.    Group II: It is fractures involving the lateral third distal to the attachment of the coracoclavicular ligament. This is further subdivided into two subgroups:

• Type A: Coracoclavicular ligament intact.
• Type B: Coracoclavicular ligament ruptured.
• Type C: Intra-articular extension into ACM joint.

3.    Group III: It is medial third fractures.

Clinical Features

The patient presents with pain, swelling, deformity and inability to raise the shoulder. Rarely, the patient may present with pseudo-paralysis of the affected arm.

Radiographs

The following views are recommended:

• Routine AP view of the clavicle.
• Lordotic view if the fracture is doubtful.
• Distal clavicle requires special radiography technique.

Treatment

Before proceeding to the treatment proper one needs to understand the two distracting forces acting on the fracture fragments in clavicle making the treatment difficult. The sternocleidomastoid muscle pulls up the medial end of the clavicle and the pectoralis major muscle and gravity acting through the arm pull down the lateral end.


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