1.Anatomical overview
The clavicle is the connecting and supporting device of the upper limb and trunk, and is S-shaped. The proximal end forms the sternoclavicular joint with the sternal stem, and the distal end forms the acromioclavicular joint with the acromion.
2. Clinical manifestations and diagnosis
After the fracture, the local deformity of the clavicle is easily detected due to its superficial location, swelling and petechiae appear, and the pain is aggravated by the shoulder joint activity.
Because there are brachial plexus nerve and subclavian vessels passing behind the clavicle, there are combined vascular and nerve injuries after the fracture.
3.Classification
Allman’s classification is the most commonly used classification method. He divided the clavicle fracture into 3 groups, Group I indicates the medial 1/3 fracture of the clavicle, Group II indicates the middle 1/3 fracture of the clavicle, and Group III indicates the lateral 1/3 fracture of the clavicle.
4.Treatment
A. Conservative treatment
(1).Adults without displacement and children with green branch fracture: triangular scarf suspension for 3-6 weeks can start the activity.
(2).Mid-segment fractures with displacement are fixed with transverse 8-way bandage after manual repositioning.
B. Surgical treatment
Surgical incision and internal fixation can be considered in the following cases.
①The patient cannot tolerate the pain of 8-way bandage fixation;
②After repositioning, re-displacement affects the appearance;
③ Combined nerve and blood vessel injury;
④Open fracture;
⑤ old fracture does not heal;
(6) Fracture of the external end of the clavicle combined with rupture of the rostral clavicular ligament.
During incision and repositioning, plate, screw or kerf pin fixation should be selected according to the fracture site, fracture type and displacement.
5.Postoperative rehabilitation exercise
The postoperative period should be protected by suspension for 4-6 weeks. Rotator cuff muscle contraction exercises should be performed 2-3 days after the internal fixation, and the orthopedic surgeon should guide the functional recovery exercises of the shoulder joint under protection. Regular radiographs will be taken to observe the healing situation and weight bearing of the affected limb will be decided according to the healing.