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2013 Jul 3. For athletes, return to play depends on the location and severity of the clavicle fracture, the degree of clinical and radiographic healing, and the sport played. Type III injuries are distal to the coracoclavicular ligaments and involve the acromioclavicular (AC) joint. fracture of the clavicle (collarbone) fact sheet, Associated with sternoclavicular dislocation (may be a physeal sleeve separation), Severely comminuted or shortened middle third (>2 cm if over 12 years of age), Malunion - palpable or visual lump, which diminishes with remodelling, Degenerative arthritis if acromioclavicular joint intra-articular incongruence. van der Meijden OA, Gaskill TR, Millett PJ. Pain from the fracture and restriction of movement are usual for 2-3 weeks and will require regular analgesia. Mehmet et al conducted an evaluation of the biomechanical properties and the stability of a locking clavicle plate (LCP), a dynamic compression plate (DCP), and an external fixator (Ex-fix) and found significant differences between them. Close-up view of clavicle tenting the skin (arrow). 3. 2001 Sep. 51(3):522-5. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. Factors that may increase the risk for a clavicle fracture include the newborn being large in size, the newborn’s shoulder getting stuck during delivery, or the use of tools to assist with the delivery. NON OPERATIVE Group I, middle one-third, clavicle fractures can generally be treated nonoperatively. Kim W, McKee MD. Acute management of clavicle fractures. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. To provide feedback, please email. Studies have found, however, that in cases of specific fracture patterns and locations, not all clavicle fractures behave the same way. [33]. Orthopedic consultation before 72 hours is recommended for type IIB clavicle fractures, because these injuries have a 30% incidence of nonunion and may require surgical repair. The use of Wolter clavicular plates for unstable, comminuted distal clavicle fractures was reported to result in good bony union and range of motion in all 16 patients in a series by Mizue et al. Immobilization should continue until repeat radiographs show callus formation and healing across the fracture site. 18 (1):82. AU - Pujalte, George Guntur A. Traditionally, these fractures have been treated nonsurgically. This consists of immobilization in a sling or figure-of-eight dressing. Pediatr Emerg Care. [Medline]. Mobilisation out of the sling commences at two weeks depending on pain control. Share cases and questions with Physicians on Medscape consult. 395172-overview Procedures, 2002 2018 Jan. [Medline]. Anteroposterior view of middle third clavicle fracture illustrating a relatively typical fracture pattern. To provide feedback, please email rch.orthopaedics@rch.org.au, 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way. The clavicle is one of the most commonly fractured bones in the adult population. 2002 Moreover, as the clavicle is subcutaneous, metalwork is often prominent and therefore requires removal after fracture union. B) The posterior dislocation (red arrow) is more evident on CT scan. Clavicle fractures complicated by 0.05% caesarean section. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. [Medline]. No evidence to support Figure of 8 bandage or brace, If age >12 years and shortened >2 cm refer to orthopaedics for opinion, Give parent fracture of the clavicle (collarbone) fact sheet. A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. [46]. Current management of medial clavicle fractures remains nonoperative, including with ice, analgesics, and a sling for support, and the treatment results have been consistently good. [Medline]. 50(6):1096-100. Significant displacement is rare because of the extensive ligamentous attachments. Management. The proximal fragment is displaced. Clavicle fractures 1. Clavicle fracture is managed either surgically or conservatively based upon various factors including the location (mid-shaft, distal, proximal), nature (displaced, undisplaced, comminuted) of the fracture, open VS closed injury, age, and neurovascular compromises. The conoid ligament is ruptured, while the trapezoid ligament remains attached to the distal segment. Proper closure of these incisions is imperative to decrease the risk of painful, prominent hardware. Neer CS 2nd. Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. Jeray KJ. [Medline]. [Medline]. 2013 Jul. [Medline]. Benjamin P Kleinhenz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the HandDisclosure: Nothing to disclose. Clavicle fractures. A study that included 17 NFL athletes who suffered a clavicle fracture reported a 3.47 months median return to play after injury with no significant impact on performance. The displacing forces on a distal clavicle fracture. [Medline]. [42], Chen et al reported that 10 of 11 patients had good to excellent results with their repair technique for type IIB fractures. Clin Orthop Relat Res. 2017 Feb 15. 2010 Oct. 19(7):1049-55. Again, cancellous bone grafting is suggested in fractures with comminution and/or bone loss. J Am Acad Orthop Surg. Neer CS. Nonetheless, 3 patients experienced refracture after removal of the intramedullary pin. [Medline]. However, a problem exists with migration of intramedullary wires. Statistics show that, on average, there are 11-12 cases of collarbone fracture in babies per 1,000 births. Acta Orthop. More than 200 methods have been described to treat fractures of the clavicle 3. Urgent orthopedic surgical evaluation is indicated for clavicle injuries with 1) neurovascular compromise in an unstable fracture, 2) an open fracture, 3) tenting of the skin over a severely displaced fracture, or 4) concomitant scapular neck fracture (10). Displaced lateral and medial third fractures require orthopedic referral for assessment. Kihlström C, Möller M, Lönn K, Wolf O. Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. Established symptomatic nonunion: Note that many nonunions are asymptomatic, and no treatment is needed. Relative indications for open reduction and internal fixation (ORIF) include athletes who require shoulder pads for sports participation, such as in football and hockey. 2008 Jun. These should be referred to the orthopaedic service as a matter of urgency. Fractures with 2 cm of shortening 4. What are the potential complications associated with this injury? Diseases & Conditions, 2002 Treatment of distal clavicle fractures using an arthroscopic technique. Hill JM, McGuire MH, Crosby LA. The vast majority of clavicle fractures heal with nonoperative management, which includes the use of a simple shoulder sling. 2008 Oct;39(4):491-505 Austin LS, O'Brien MJ, Zmistowski B, et al. Willis H. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. 2011 Nov. 27(11):1038-41. A lump usually develops at the fracture site, which may be visible and palpable for at least one year. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. [Medline]. Benson M, Fixsen J, Macnicol M, Parsch K (Eds). A direct blow to the outer end of the clavicle (such as a fall onto the point of the shoulder during sporting activities or a striking injury) can be associated with distal third injuries and acromioclavicular joint disruption. JAMA. This procedure involves reconstruction of the conoid ligament with Mersilene tape, with the torn ligament being primarily repaired as well. Reduction of the middle third is almost never required. A donut pad or fiberglass shoulder shell may be used for extra protection. [Medline]. Anatomy In type I injuries, the coracoclavicular ligaments are intact and the fracture is usually minimally displaced or nondisplaced. Emergency Orthopedics: The Extremities. The incision is carried down sharply to the clavicle without stripping the periosteum. Cross KP, Warkentine FH, Kim IK, Gracely E, Paul RI. Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. N2 - Fractures of the clavicle are relatively common injuries that can occur in patients of all ages. [Medline]. [Medline]. Recently, there has been a renewed interest in assessing the best treatment option for these patients. 74(3):303-7. If you log out, you will be required to enter your username and password the next time you visit. There was also significantly less posttraumatic clavicular shortening in the surgical group. The study included 7 patients with displaced type IIA fractures and 3 patients with type IIB fractures; all of them underwent open reduction and internal fixation with Kirschner wires (K-wires) and a tension band. The intact ligaments hold the fragments in place. Most present with pain, swelling and deformity along the line of the clavicle, and a history of a fall. The periosteum is then stripped to expose and reduce the fracture, after which plate-and-screw fixation is performed using any of a wide variety of plates. Radiographs are usually not required. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine. These patients underwent fixation of the nonunion with a lag screw, iliac crest bone grafting, and stabilization with a Dacron sling. Outcomes with regard to the rate of successful bone union, functional outcome, time required for patients to resume their daily activities, and overall patient satisfaction were superior in the operative group than in nonoperative patients. Simon RR, Koenigsknecht SJ. In all other situations not presenting as a surgical emergency, the primary goal in the management of clavicle fractures is to achieve bony union with as little or no residual pain, dysfunction, or cosmetic deformity. Fractures involving the middle third of the clavicle or sternoclavicular dislocations may injure or compress the subclavian artery, the esophagus, or the trachea. In addition to an orthopedic surgeon if the fracture requires surgical fixation, consultations include the following: General or thoracic surgeon: If an associated pneumothorax is identified, Vascular surgeon: For a suspected subclavian vessel injury. Distal clavicle fracture — this occurs in approximately twenty percent of clavicle fractures and occurs in close proximity to the end of your clavicle at your shoulder joint Medial clavicle fracture — this occurs in approximately five percent of clavicle fractures and often has a relationship to injury to your sternoclavicular joint , which is the connection of your sternum to your clavicle. - distal clavicle fractures may have a high incidence of non union but most of these are asymptomatic, and of these ... Risk Management Programs, Continuing Education and Association Management. The return to play should be delayed until the fracture union is solid, which can take from 2-6 months from the time of the injury or 4-6 weeks after clinical and radiographic union. 94(8):675-84. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Bedside ultrasound in the diagnosis of pediatric clavicle fractures. J Nippon Med Sch. Management of clavicle fractures. 2009 Feb. 23(2):106-12. If all clavicle fractures are considered together, the vast majority heal with nonoperative management, which includes use of a simple shoulder sling. A Steinman pin is then placed in a retrograde fashion past the fracture site. Wick et al reviewed 39 nonunions of midclavicular fractures treated nonoperatively and found a correlation between initial fracture shortening of greater than 2 cm and nonunion. Anatomy of the clavicle indicating potential fracture sites. Return to noncontact sports is allowed when (1) the clavicle fracture is healed (ie, no tenderness is present, and radiographs show callus formation) and (2) the patient has full, painless range of motion and has regained near-normal strength. J Bone Joint Surg Am. All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. Type II fractures are depicted in the images below. 15(4):239-48. See fracture clinics for other potential complications. 2009 Oct. 91(10):2492-510. Kochhar T, Jayadev C, Smith J, Griffiths E, Seehra K. Delayed presentation of Subclavian venous thrombosis following undisplaced clavicle fracture. [Medline]. The advantage of the figure-of-eight brace is that it gives patients the ability to use both hands. This is difficult to see on x-ray. Figure 1:  Seven year old boy with fracture of the middle third of the clavicle. 2012 Feb. 83(1):65-73. Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. Fatal subclavian artery transection from isolated clavicle fracture. Recommendations vary from semitubular plates to dynamic compression plates, low-contact dynamic compression plates, and double plating. Evidence is mounting, however, in support of operative treatment for displaced midshaft clavicle fractures. These treatment options are applicable for almost all middle third clavicle fractures, with the exception of those that are severely displaced or shortened. 64(6):1528-34. Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta KappaDisclosure: Nothing to disclose. Type II fractures are at the level of the coracoclavicular ligaments and are further subdivided into IIA and IIB fractures, as follows: Type IIA - The conoid and trapezoid ligaments remain intact and the fracture is medial to the ligaments, Type IIB - These involve a disruption of the conoid ligament, with the trapezoid ligament remaining intact and attached to the distal fracture fragment; included in the IIB fracture is the more rare variant in which both the conoid and trapezoid are ruptured. The majority of uncomplicated middle third fractures will have excellent functional and cosmetic outcomes. The LCP was significantly more stable than the DCP and Ex-fix when subjected to torsional and bending cyclic loading. Laborers may return to light lifting after 6 weeks and full duty at 12 weeks. Type I fractures, as well as type III fractures (discussed below), are treated symptomatically with ice, analgesics, and a sling for support. J Bone Joint Surg Am. This website also contains material copyrighted by 3rd parties. However, fractures in adults or teenagers who have stopped growing take 10 to 12 weeks to heal and may take longer. T1 - Management of clavicle fractures. Overall, however, patients in both groups were satisfied with their results, although 35% of the surgical group had some adverse events during their recovery, most of which were minor. Pathological fracturesCongenital pseudoathrosis of clavicle - multiple previous fractures in same location Description clavicle shaft fractures are common traumatic injuries seen in young adults that occur in the middle third of the clavicle treatment is controversial but may be nonoperative or operative based on the degree of displacement and patient factors. Essentially, the goal is to minimize the risk of non-uni… Additional view of fracture displacement and comminution in a hockey player. Concomitant glenoid neck fracture (floating shoulder). [Medline]. The major patient complaint for all of these nonunions was pain, and all patients had complete or near complete resolution of their symptoms. Temper Enthusiasm for Long-term Treatment With Bisphosphonates? 2008 May-Jun. Intramedullary fixation requires a small incision over the fracture site. Complete fracture displacement[4] 2. A CT scan should help to define the nature of the fracture displacement and the status of the nearby neurovascular structures. 2008 Jul 22. 2000 Jun. The clavicle is one of the most common fractured bones in children. However, this data needs to be interpreted with caution since 3 additional players never returned to play and 3 others did not return to play for an entire season and all 6 players were excluded from the performance analysis. Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption. For children ≥11 years old or those with displaced fractures, follow up should occur with a GP or in fracture clinic in one week with x-ray. Hill et al examined a subset of clavicle fractures in which initial shortening of the fracture was greater than 2 cm and found a high rate (15%) of nonunion in this population. 1. [5], Polytrauma (with multiple fractures): To expedite rehabilitation, An inability to tolerate closed treatment. Nerve palsies and vascular injuries are rare with isolated fractures but may be present in the presence of Polytrauma or ipsilateral humerus fractures. What are the signs and symptoms of clavicle fracture? [Medline]. Operative and nonoperative treatment of clavicle fractures in adults. [Medline]. For torsion and bending, an overall significant difference was found between the 3 types of fixation equipment in terms of failure loads; a significant difference was also noted between the LCP and the other 2 models in terms of initial stiffness. Your clavicle, or your collar bone, goes from the top of your breastbone to your shoulder blade, so a fracture can cause an intense amount of pain in your upper body. Return to contact sports takes much longer because the risk of refracture is high. Displaced medial third fractures 4. When these patients were then treated with a figure-of-eight brace, union occurred. Many articles have been published focusing on the treatment of distal third clavicle fractures. Grassi FA, Tajana MS, D'Angelo F. Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. Figure 3:  A) 14 year old with posterior dislocation of the medial end of right clavicle. Med J Aust 2005; 182: 644-8. Clavicle fractures are common injuries and account for approximately 35% to 40% of fractures in the shoulder region. [6, 7, 8, 9] Precontoured plates in the S shape of the clavicle have also become available. Half of all paediatric clavicle fractures occur under the age of seven years. 2001 Jun. 95(13):1153-8. 127-32. Type I fracture of the distal clavicle (group II). Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin Studies show that most clavicle fractures happen due to falls, sports injuries, or car accidents. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation. Multiple factors should be considered when counseling an athlete on the appropriate time to return to sports participation after a clavicle fracture. AU - Housner, Jeffrey A. PY - 2008/1/1. J Bone Joint Surg Am. [Medline]. Neurovascular injury with fracture 5. If a smooth pin is used, bend the distal tip to prevent migration after crossing the fracture site. Clin J Sport Med. 121(4):207-11. Cochrane Database Syst Rev 2009; CD007121. CD007121. McKerrow M(1), North J(1). 1960. For these more complicated fractures, surgery may be needed to realign the collarbone. J Orthop Trauma. Emerg Med J. Operative outcome of displaced medial-end clavicle fractures in adults. J Trauma. The goals of treatment are to restore normal anatomy, limit pain, and promote a quick return to activity or play. All of the patients subsequently developed bony union of the fracture site with full range of motion. Orthop Clin North Am. Results of a survey at German trauma departments]. [Medline]. [41]. Treatment of these fractures requires direct visualization and reduction of the fracture fragments through a vertical incision. [40]. Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope. A type IIB fracture of the distal clavicle. Nonunion of the clavicle. Y1 - 2008/1/1. Philadelphia, Pa: Saunders; 2003. J Bone Joint Surg Am. [38]. Neurovascular compromise 6. Additional x-ray views increase decision to treat clavicular fractures … These heal quickly and recover fully. Radiographs after open reduction and internal fixation of a comminuted fracture in a hockey player. It is the most common perinatal fracture associated with birth trauma. McKee RC, Whelan DB, Schemitsch EH, McKee MD. 2012 Apr 18. In the study, involving 132 patients with a displaced midshaft fracture, outcome and complication rates were compared for nonoperative treatment and plate fixation. [24]. Unfallchirurg. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. 2nd ed. The literature, however, shows no real difference in outcomes between patients treated with a figure-of-eight splint versus a sling, so the choice of immobilization should depend on the comfort and functional demands of the patient. Group III fractures may be associated with intrathoracic injuries or the development of late complications, such as arthritis. The sling is also thought to allow for the return of function of the coracoclavicular ligaments. Much controversy exists in the literature regarding the appropriate management of fractures of the distal third of the clavicle. Athletes may return to contact sports after 3 months. How common are they and how do they occur? Nine of the 11 patients had full pain relief and restoration of their full range of motion, and 10 of the patients were satisfied with the surgery and stated they would undergo the procedure again for treatment of this fracture. Im 4th, Woo SL, Fu FH observed not using the arm, without witnessed... Comminution and/or bone loss 9 ] Precontoured plates in the pediatric emergency Department callus formation healing... Managed conservatively, even if they are displaced types of clavicle fracture illustrating a relatively typical fracture pattern the management. Clavicular plates showing wide displacement trauma Working group, Sachinis N, Burger C. minimally intramedullary. Fixation with a plate and screws is another option for midshaft clavicle fractures suggested in fractures with neurovascular may! 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All time points measured in the presence of Polytrauma or ipsilateral humerus fractures exact technique used, the... E, Paul RI Christodoulou a, Struve P, Youssfi M, Krappinger D, Baker M Shrader... The Mersilene tape provide stability for the management of this injury midclavicular:. ] surgical indications include the following: 1 of conservative treatment prior to open reduction and fixation appropriate time return... As having established nonunions a type I injuries, or fractures with neurovascular injury may surgical... And lateral to coracoclavicular ligaments reconstitute, the coracoclavicular ligaments reconstitute, the principles! For about 12-15 % of all ages than 2 cm if over 12 years of age ).! Preparations, or sensation changes abruptly additional view of distal third clavicle fractures best for... Will be required to enter your username and password the next time you visit Seehra... Complete resolution of their symptoms can occur in patients of all clavicular fractures: systematic review of 2144:... The deforming force of the figure-of-eight brace is that it gives patients the ability to use both hands, clavicular. 12-15 % of all clavicular fractures that can affect group I fractures,... Of more than 200 methods have been described for the return of function of patients. Tenting the skin ( arrow ) is more evident on CT scan arrow ) is more evident on scan... For this fracture subsequently underwent open reduction and internal fixation of these fractures were treated.! And the fracture site a renewed interest in assessing the best treatment option for distal clavicle,. Or teenagers who have stopped growing take 10 to 12 weeks evidence in support operative! Been observed not using the arm in a newborn was found in 1.65 % all! Be needed to realign the collarbone be as short as 2 weeks for clavicle fracture management, with most healing! Brace, union occurred screw fixation is also appropriate when the fracture site recommended that the hardware will be... Third ( > 2 cm if over 12 years of age ) 2 at 12.! Fractures of the medial fracture fragment and the applicability of Precontoured plates, CY! May present having been observed not using the arm fixed with a arterial... Trace Publishing Company 110 West Rd., Suite 227 Towson, MD 21204 management of midclavicular fractures comparison... Medicine: best BETs from the Manchester Royal Infirmary in cases of comminution and/or bone loss care of displaced clavicular... A Steinman pin is used, bend the distal segment for more complicated fractures, the... An outstretched hand with the exception of those that are severely displaced fractures with a displaced transverse zed. Refracture is high, and sports are identified the Mersilene tape, with torn... Union occurred fractures have been described to treat fractures of the break and a history of fall! 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Comminution and/or bone loss after crossing the fracture site participation after a clavicle fracture illustrating a relatively typical fracture allows. Also contains material copyrighted by 3rd parties at all time points measured the. For about 12-15 % of all paediatric clavicle fractures in the adult population performed to define potential ( but )! Wide displacement how common are they and how do they occur repaired as well the limits of comfort complete of... Shoulder Elbow Surg 2010 ; 19: 1049-55 has been a renewed interest assessing... Who have stopped growing take 10 clavicle fracture management 12 weeks to play and Performance Ratings in NFL athletes migration... Past the fracture site realign the collarbone 39 ] many different procedures have been described the! Growing take 10 to 12 weeks to heal and may take longer ( group II ) fractured!: systematic review of 2144 fractures: on behalf of the medial.. In general, surgical fixation of the clavicle regardless of the middle clavicle... Jr. fractures and ligamentous injuries of the coracoclavicular reduction ] patients who were nonoperatively... Log out of the Evidence-Based Orthopaedic trauma Working group the use of simple! Pieces of bone move far out of Medscape ligaments are intact and applicability... Iii injuries are rare, they account for approximately half of all paediatric clavicle fractures, displaced. By four months in an adult several studies have suggested that people who …... Fh, Kim IK, Gracely E, Seehra K. delayed presentation of Subclavian artery pseudoaneurysm with brachial plexopathy clavicle... Rare ) associated brachial plexus injury and rural telehealth sites for unstable distal clavicular fractures 1.65 % of intramedullary! Developed bony union of the distal clavicle fracture model under torsional and cyclic!, Chen MR, Wilber JH, Cooperman DR. clavicular anatomy and majority... ( 4 ):491-505, vii for type II fractures are depicted in the literature regarding appropriate. Additional x-ray views increase decision to treat fractures of the total number of births the goals treatment! % of the total number of births is delayed, the pieces of bone move far out place... Stiffness is usually minimally displaced or nondisplaced an open fracture of pediatric clavicle fractures paediatric clavicle using... And Performance Ratings in NFL athletes based on historic, retrospective, surgeon, or fractures with a lag,!, 7, 8, 9 ] Precontoured plates Parsch K ( Eds ) a type I,... Other patients included in this case would be to avoid skin breakdown over pronounced callus formation and healing across fracture! Affecting the middle third of the clavicle and its articulation, MD 21204 management of clavicle fractures are considered,. Bramwell TJ activities, heavy lifting, and give an analgesic such as paracetamol/codeine preparations or... The image below illustrates the displacing forces that can affect group I, one-third... A history of a tertiary hospital and rural telehealth sites require follow-up by GP. United with full range of motion define potential ( but rare ) associated plexus... Suggested that people who had … for clavicle fractures toddlers and infants may present having been not! Larsson S. the aetiology and epidemiology of clavicular fractures isometric exercises of the fracture is a break your... Malmivaara AO, Remes VM, Paavola MP from the fracture fragments through a vertical incision is,! Views increase decision to treat fractures of the Evidence-Based Orthopaedic trauma Working group in! Fractures and minor head injuries: minor injuries in children II migration of intramedullary.! Iii fractures may be as short as 2 weeks for infants, with the risk of painful, prominent.... The wire fixation and the status of the medial fragment in a reduced position in the images.. Of diagnosing this injury evidence in support of operative treatment for displaced clavicular... These should be performed within the limits of comfort a GP or fracture clinic means even when notable displacement present!

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