Understanding Medial Clavicle Fractures

Medial clavicle fractures, while lesscommon than those in the middle or distal third of the bone, present uniquecharacteristics and considerations for treatment.

●Epidemiology:

○Medial clavicle fractures account for lessthan 3% of all clavicle fractures

○One study found that 78% of medialclavicle fractures occurred in men, with an average age of 48 years.

○Road traffic accidents are the mostfrequent cause of medial clavicle fractures (64%), followed by falls (22%).

●Mechanism of Injury and AssociatedInjuries:

○The high incidence of segmentalfractures (9%) and chest trauma (49%) suggests a link to high-energytrauma.

○This distinguishes them from claviclefractures as a whole, which are more commonly caused by simple falls.

○It's crucial to carefully assess for otherinjuries in patients with medial clavicle fractures due to the significantforces involved.

●Treatment:

○Nonoperative treatment, such asimmobilization with a sling, is the most common approach for medialclavicle fractures.

○This approach has been associated with a highunion rate and generally good functional outcomes

○Operative treatment, though lessfrequent, may be considered in cases of symptomatic or grossly unstableinjuries.

○Surgical options can include plating,intramedullary nailing, and in rare cases, clavicle resection.

Plates:Plating is a common method of fixation for various types of fractures, and ithas been reported in the treatment of medial clavicle fractures.

■Different types of plates have beenutilized, including low-profile plates, locking plates, and inverted distalclavicle locking plates.

■Challenges with Plating:

●Finding a plate that adequately fits themedial clavicle can be challenging.

●Plate irritation and the need forsubsequent plate removal surgery are common complications.

●Specific Considerations:

○Shortening of the clavicle after afracture can impact clinical outcomes, so this should be carefully evaluated.

○The presence of comminution (the bonebreaking into multiple pieces) doesn't necessarily worsen fracture healingwhen managed conservatively.

○Patient age, fracturedisplacement, and the presence of associated injuries are allfactors that can influence treatment decisions.

●Further Research:

○While the existing literature suggestspositive outcomes for nonoperative treatment of medial clavicle fractures, morehigh-quality research is needed

○This research should aim to better definethe indications for both nonoperative and operative management, and tofurther investigate long-term outcomes