Materiały źródłowe

• #1 Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1444-1

  Large multi-centre studies of clavicle fractures have so far been missing. The aim of this observational study was to describe the epidemiology, classification and treatment of clavicle fractures in the The Swedish Fracture Register (SFR) that collects national prospective data from large fracture populations. […] Clavicle fractures have been registered since April 2012. […] The incidence of clavicle fractures in Sweden increased from 35.6 per 100,000 person-years in 2001 to 59.3 per 100,000 person-years in 2012. […] In this observational study of clavicle fractures in Sweden, the largest patient group was males younger than 25 years of age and the most frequent causes of injury were same-level falls, bicycle and motorcycle accidents. Displaced midshaft fractures were the most common type of fracture. These fractures, together with extra-articular displaced lateral fractures, were also the most frequently operated fractures. Seventeen per cent of the fractures underwent operative treatment within 30 days of the injury, most commonly with plate fixation. […] This study serves as an up-to-date overview of modern clavicle fractures that will hopefully provide a framework for future research on the treatment of clavicle fractures.

• #2 Clavicle Fractures: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/92429-overview

  The clavicle is the most frequently fractured bone in the body in childhood, accounting for 10-16% of all fractures in this age group. […] In adults, clavicle fractures account for 2.6-5% of all fractures and 44% of all shoulder girdle injuries. […] Middle third (group I) fractures account for 69-82% of all fractures of the clavicle, whereas distal third (group II) fractures account for 12%, and medial third (group III) fractures occur in 6% of cases. […] Clavicular injuries affect 1 in 1000 people per year. […] Bimodal incidence occurs in men younger than 25 years and older than 55 years. […] The annual incidence rate of clavicular fractures is estimated to be between 30 and 60 cases per 100,000 population. […] An analysis of 2,422 clavicle fractures in patients 15 years of age and older from 2013-2014 recorded in The Swedish Fracture Register reported that 21% of all fractures occurred in males 15-24 years of age and that 43% of all fractures were displaced midshaft fractures.

• #3

  https://www.orthobullets.com/trauma/1011/clavicle-fractures–midshaft

  Midshaft Clavicle fractures are common traumatic injuries caused by a direct impact to the shoulder girdle and is most commonly seen in young, active adults. […] Clavicle fractures account for 2.6-4% of all adult fractures. […] Incidence: 1 in 1000 people per year. […] Often seen in young, active patients, most common in males 30 years old. […] 75-80% of all clavicle fractures will occur in the middle third segment.

• #4

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9597028/

  Clavicle fractures are common orthopaedic injuries that frequently occur during sports and recreational activity. […] To (1) determine the incidence rate of sports-related clavicle fractures among patients evaluated in emergency departments in the United States over a 5-year period, (2) determine the most common sports and risks associated with clavicle fractures, and (3) update the literature by comparing past and present injury trends. […] A total of 2386 athletic-related clavicle fractures were evaluated at participating emergency departments, translating to 304,211 clavicle fractures, with an annual per-year injury rate of 18.72 clavicle fractures per 100,000 persons at risk (95% CI, 15.28-23.67). […] Study findings indicated that clavicle fractures sustained during sports and recreational activity disproportionately affect male athletes.

• #5 Pediatric Clavicle Fractures and Congenital Pseudarthrosis Unraveled

  https://www.mdpi.com/2227-9067/9/1/49

  Clavicle fractures account for 10–15% of all pediatric fractures. The majority of patients with a clavicle fracture are male (91.2%), and most clavicle fractures are seen between the ages of 10 and 19 years (incidence rate of 91.7 per 100,000). Fractures on the left side (58%) and on the non-dominant side (56%) are slightly more common. Most clavicle fractures occur in the middle section of the bone, accounting for 70% to 95% of all pediatric clavicle fractures. Displaced fractures of the clavicle are relatively common, ranging from 28% to 67% of all clavicle fractures in children and adolescents. […] Clavicle fractures occur most frequently as a result of sports (66%), horseplay (12%), riding a bike (6%), a fall (6%) or another type of accident (3%). However, clavicle fractures may also occur during childbirth, particularly in the case of shoulder dystocia. Although less than 4% of all children are born with this fracture, it is the most common fracture during childbirth, accounting for almost a third of all birth traumas.

• #6 Clavicle Fractures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507892/

  Clavicle fractures represent 2% to 10% of all fractures. Clavicle fractures affect 1 in 1000 people per year. They are the most common fractures during childhood, and approximately two-thirds of all clavicle fractures occurring in males. There is a bimodal distribution of clavicle fractures, with the 2 peaks being men younger than 25 (sports injuries) and patients older than 55 years of age (falls). Approximately 20 percent of females and more than one-third of males with clavicular fractures are between 13-20 years old. […] The middle third of the clavicle is fractured in 69% of cases, the distal third is fractured in 28% of cases, and the proximal third is fractured in 3% of cases. […] The middle third of the clavicle represents 95% of fractures seen in children. In children younger than 10, these are frequently nondisplaced, while in children older than 10 the majority are displaced. Clavicle fractures represent 95% of fractures seen during childbirth.

• #7 Clavicle Fractures: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/92429-overview

  Clavicular injuries occur 2.5 times more commonly in males than in females, reflecting a greater involvement of males in contact and violent sports and motor vehicle accidents (MVAs). […] Clavicle fractures, the most common of all pediatric fractures, can present even in the newborn period, especially following a difficult delivery. […] A large peak incidence occurs in males younger than 30 years due to sports injuries. […] A smaller peak occurs in elderly patients, who tend to sustain clavicle fractures (in association with osteoporosis) during low-energy falls.

• #8 Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. | Read by QxMD

  https://read.qxmd.com/read/28202071/clavicle-fractures-epidemiology-classification-and-treatment-of-2-422-fractures-in-the-swedish-fracture-register-an-observational-study

  Sixty-eight per cent of the clavicle fractures occurred in males. The largest subgroup was males aged 15-24 years, representing 21% of clavicle fractures. At the ages of 65 years and above, females sustained more clavicle fractures than males. Same-level falls and bicycle accidents were the most common injury mechanisms. Displaced midshaft fractures constituted 43% of all fractures and were the most frequently operated fractures. Seventeen per cent of the patients underwent operative treatment within 30 days of the injury, where plate fixation was the choice of treatment in 94% of fractures. […] The largest patient group was young males. Displaced midshaft fractures were the most common type of clavicle fracture as well as the most frequently operated type of fracture.

• #9

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9597028/

  Adolescent populations (10-19 years of age) had the highest overall incidence of injury, and the most common activities associated with clavicle fractures were football and soccer. […] Clavicle fractures account for 2.6% to 5% of all reported fractures and are one of the most common orthopaedic injuries that occur during sports and recreational activity. […] Several studies have estimated that sports-related injuries are responsible for 45% of clavicle fractures in the United States, and male athletes aged 10 to 19 years have the highest likelihood of injury. […] The aims of the current study were to use the US Consumer Product Safety Commissions National Electronic Injury Surveillance System (NEISS) database to (1) determine the incidence rate of sports-related clavicle fractures evaluated at emergency departments in the United States, (2) identify the most common sports and recreational activities and high-risk populations associated with clavicle fractures, and (3) compare the current rates and risk factors for clavicle fractures with previous trends in the literature.

• #10

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9597028/

  Overall, the most common sports and recreational activities occurring at the time of clavicle injury were football (26.87%; n = 641), soccer (15.76%; n = 376), snowboarding (5.03%; n = 120), bicycling (3.77%; n = 90), wresting (3.65%; n = 87), and snow skiing (3.52%; n = 84). […] Participants in sports and recreational activities evaluated at the emergency department with clavicle fractures were disproportionately male adolescents (age, 10-19 years).

• #11 Clavicle fractures – UpToDate

  https://www.uptodate.com/contents/clavicle-fractures

  Clavicle fractures account for approximately 2.6 percent of all fractures. The peak incidence occurs in children and young adults. Over one-third of clavicle fractures in males occur between the ages of 13 and 20 years, while 20 percent of clavicle fractures in women occur in the same age group. Incidence falls over subsequent decades before rising again in older men and women. […] In a study of 1000 consecutive fractures, 69 percent occurred in the middle third of the bone, 28 percent in the distal third, and 2.8 percent in the proximal third. Distal third fractures are further subdivided into three types. […] In older studies, fractures of the medial clavicle constituted only 2 to 3 percent of all clavicle fractures. However, a subsequent study found that 9.3 percent of clavicle fractures involved the medial third. The authors hypothesized that their higher rate was due to the institution’s liberal use of computed tomography (CT; 22 percent of medial clavicle fractures were seen only on CT).

• #12 Broken Collarbone Symptoms, Diagnosis, Treatment, and Care

  https://www.healthline.com/health/broken-collarbone

  Broken collarbones (also called clavicle fractures) are fairly common, representing about 5 percent of all adult fractures. Clavicle fractures are even more common in children, representing between 8 and 15 percent of all child fractures. […] A 2016 Swedish study found that 68 percent of clavicle fractures occurred in males. The 15- to 24-year-olds represented the largest age group among males, at 21 percent. But in people older than 65, more women than men had broken collarbones. […] Sports injuries, falls, and traffic accidents are the most frequent causes of broken collarbones. […] Treatment for a broken collarbone depends on the type and severity of your fracture. […] Broken collarbones usually take six to eight weeks to heal for adults and three to six weeks in young children. […] Broken collarbones are fairly common and usually heal without complications.

• #13 Clavicle Fractures | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0101/p65.html

  Clavicle fractures are most common in children and young adults, typically occurring in persons younger than 25 years. […] Clavicle fractures constitute 5 to 10 percent of all fractures. Most occur in men younger than 25 years; however, they are also more common in men older than 55 and in women older than 75. […] The anatomic site of the fracture is typically described using the Allman classification, which divides the clavicle into thirds. Midshaft fractures account for approximately 75 to 80 percent of all clavicle fractures and typically occur in younger persons. Distal third fractures represent about 15 to 25 percent of clavicle fractures. Medial third fractures are least common, accounting for less than 5 percent of clavicle fractures. […] The usual mechanism of a clavicle fracture is a fall directly on the shoulder with the arm at the side. Rarely, clavicle fractures can occur from a direct blow or from a fall on an outstretched hand. In children and young adults, these injuries are typically related to sports participation, especially in contact sports such as football and rugby where participants are driven to the ground and land with the weight of their opponent on top of them.

• #14 Clavicle fractures | Musculoskeletal Key

  https://musculoskeletalkey.com/clavicle-fractures-9/

  Fractures of the clavicle account for approximately 2.64% of all fractures, and 3544% of all fractures involving the shoulder girdle, making it one of the most commonly fractured bones in the human body. Bone quality declines slowly after 30 years of age and osteoporosis most commonly develops after the age of 50. Osteoporotic bone is known to have a greater propensity to fracture, and elderly patients have a greater propensity to fall. Taken together, it would seem that clavicle fractures would be most likely to occur in elderly individuals. Surprisingly, this is not observed in practice, as clavicle fractures are most commonly observed young males. However, there is a second, smaller peak in elderly patients, and this peak has nearly equal male and female preponderance. Among patients aged 61 and over, 10% of clavicle fractures involve the medial third, 67% the middle third and 23% the lateral third. Therefore, while middle third fractures remain the most common subgroup, there is a higher proportion of both lateral and medial third clavicle fractures in the elderly compared to the younger population. For midshaft fractures, patients over 50 have a higher incidence of comminuted and displaced fractures than patients below 50. Since the fracture mechanism is more commonly low energy in older patients, the increased complexity of fracture morphology in elderly patients can likely be attributed to poor bone quality.

• #15 Clavicle fractures – UpToDate

  https://www.uptodate.com/contents/clavicle-fractures

  Approximately 87 percent of clavicle fractures are caused by a fall onto the shoulder. Traffic accidents and sports account for most fractures among the young. Of injuries caused by traffic accidents, 39 percent occur in cyclists, 26 percent in car drivers or passengers, 17 percent in pedestrians, and 17 percent in motorcyclists. […] Clavicle fractures reportedly comprise 95 percent of fractures during childbirth. In the newborn, such fractures are more commonly associated with difficult deliveries, such as shoulder dystocia or breech.

• #16 Clavicle fractures – Don’t Forget the Bubbles

  https://dontforgetthebubbles.com/clavicle-fractures/

  Clavicular fractures are the most common shoulder fracture in children (8% to 15% of all paediatric fractures). They are common during delivery, too, and occur in 0.5% of all normal and 1.6% of breech deliveries, accounting for 90% of obstetric fractures. […] Midshaft clavicular fractures are the most common paediatric shoulder fractures, accounting for 10-15% of all fractures. […] Non-union can occur in up to 5% of all types of clavicular fractures. Clavicular injuries that are most at risk of non-union include comminuted fractures and 100% displaced fractures with shortening that is over 2cm, resulting in decreased shoulder strength and endurance.

• #17 Simultaneous bilateral traumatic clavicle fractures: incidence, characteristics, and surgical outcomes | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06228-w

  From October 2013 to November 2021, 15 patients (10 men, 5 women) were diagnosed with bilateral clavicle fractures among 1542 patients with clavicle injuries (overall incidence of 1.0%). […] Although fractures of the clavicle are among the most frequent fractures in adults, simultaneous traumatic bilateral clavicle fractures in adults are reported more rarely. […] Based on the few published reports, bilateral clavicle fractures represent less than 0.5% of all clavicle fractures. […] Our study showed that bilateral clavicle fractures accounted for nearly 1% of all clavicle fractures, which is a slightly higher incidence than reported by van den Bout. […] The mechanism of sustaining bilateral clavicle fractures is different from that of a unilateral clavicle fracture. […] All patients in the present study were injured by high-energy trauma, including eight car accidents, one machine injury, one bicycle accident, two crashes, and one motorcycle accident.

• #18

  https://link.springer.com/article/10.1007/s00068-021-01701-4

  The aim of this systematic review was to provide an overview of the incidence of combined clavicle and rib fractures and the association between these two injuries. […] Among blunt chest trauma patients, 18.6% had concomitant clavicle and rib fractures. The incidence of rib fractures in polytrauma patients with clavicle fractures was 5660.6% versus 29% in patients without clavicle fractures. […] Clavicle fractures and rib fractures are closely related in polytrauma patients and almost a fifth of all blunt chest trauma patients sustain both injuries.

• #19 Clavicle fractures | Musculoskeletal Key

  https://musculoskeletalkey.com/clavicle-fractures-5/

  Clavicle fractures, particularly those associated with higher energy trauma, are commonly associated with other injuries. Elderly patients have less ability to tolerate these injuries, which is reflected by the finding in the orthopaedic literature that the elderly are 44.6 times more likely to die than younger patients as a result of a traumatic event of similar severity, and age older than 65 years is an independent predictor of death after trauma. The presence of a clavicle fracture may be a particular sign of associated injuries and subsequent poor outcomes in higher energy geriatric trauma patients. Of all long bone fractures, the presence of a clavicle fracture is the strongest predictor of mortality in the geriatric trauma population, with a mortality rate of 23% in those patients (compared to a mortality rate of 13% in geriatric trauma patients without clavicle fractures). In contrast, young major trauma patients with clavicle fractures have a mortality rate of only 7%.

• #20

  https://link.springer.com/article/10.1007/s00068-022-02029-3

  Describing the epidemiological profile of patients with acute clavicle shaft fractures in a developing country public state hospital where mainly low- to middle-income patients are treated. […] The epidemiology of clavicle shaft fractures in a public hospital in a developing country, where the majority of patients hail from low- to middle-income backgrounds, differs substantially from developed countries. Although similar types of fractures were reported, differences were noted in terms of patients age, causes of injury, associated injuries and treatment approaches.

• #21 Simultaneous bilateral traumatic clavicle fractures: incidence, characteristics, and surgical outcomes | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06228-w

  In the past, most bilateral clavicle fractures were managed conservatively. […] However, conservative management of bilateral clavicle fractures was associated with more pain and a high risk of nonunion and shoulder dysfunction, rendering the patient incapacitated. […] Recent reports have advocated operative measures for bilateral clavicle fractures. […] Surgical treatment with plate fixation can result in an excellent outcome in terms of early rehabilitation and return of function, especially when associated severe chest injuries are present.

• #22 Clavicle Fractures | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0101/p65.html

  Complications from midshaft clavicle fractures are rare, despite the proximity of neurovascular structures and lung apices, but include pneumothorax and neurovascular injury. Long-term sequelae include pain at rest or during activity, weakness, paresthesia, and cosmetic defects. Displacement of more than one bone width is the strongest radiographic risk factor for symptoms and sequelae. […] Distal clavicle fractures are rare in children, and when they occur, the mechanism is often a fall on the point of the shoulder.

• #23 Subclavian vessels injury: An underestimated complication of clavicular fractures

  https://www.wjgnet.com/2220-3141/full/v13/i4/98579.htm

  Clavicular fractures are a common musculoskeletal injury, accounting for approximately 2.6% to 5% of all adult fractures and 35% to 44% of acute shoulder girdle injuries. The midshaft portion of the clavicle is the most frequently affected location, constituting about 62% to 81% of all clavicular fractures. The subclavian vessels may be damaged at the time of the initial injury or during fracture fixation or even in the course of conservative management of clavicle fractures. The overall incidence of subclavian vessel injury after clavicular fractures is relatively low and estimated at around 0.3% to 3%. Despite the rarity of the complication, the implications of such injuries are severe and potentially catastrophic as subclavian vessels are the main conduits responsible for the blood supply of upper limbs. Studies have shown that subclavian vessel injuries are more likely to occur in clavicle fracture patterns with significant displacement and comminution or after high-energy trauma, such as motor vehicle accidents and falls from height. Additionally, clavicular fractures combined with penetrating upper extremity and chest trauma have a higher incidence of vascular injuries compared to blunt trauma. These conditions can lead to life-threatening complications including hemorrhage, ischemia and nerve damage, requiring urgent diagnosis and accurate intervention. A comprehensive review by Katras et al, which included patients suffering from clavicular fractures complicated by vascular injuries, showed that the majority of those conditions needed immediate surgical intervention, highlighting the importance of early detection and management. Moreover, another study by Smith and Gupta emphasized that the diagnosis of subclavian vessel injury might be substantially delayed due to the overshadowing presence of the more obvious fracture symptoms and pain.

• #24 Clavicle (Collar Bone) Fractures | Boston Shoulder Institute

  https://bostonshoulderinstitute.com/patient-resources/modules/clavicle-collar-bone-fractures-2/

  Clavicle fractures have been reported to represent 2.6% of all fractures (Postacchini et al.). Nordqvist and Petersson have reported the incidence of clavicle fracture to be 64 per 100,000 fractures per year. […] Zlowodzki et al. (JOT 19:504-7) reported that non-union (fracture does not heal) of displaced fracture treated non-operatively were 15% and treated operatively with plates were 2.2%. When using a pin/rod, the non-union rate was 2.0%. […] Given this high rate of nonunion, many clinicians are proponents of operative intervention for type II distal clavicle fractures.

• #25 Clavicle fractures | Musculoskeletal Key

  https://musculoskeletalkey.com/clavicle-fractures-9/

  Anteroposterior (AP) radiographs of the clavicle are sufficient to diagnose clavicle fractures and should be performed in all elderly patients complaining of shoulder pain after trauma. A chest radiograph may also suffice, and in some cases provides additional information by including the contralateral clavicle for comparison, and will likely be needed as part of the preoperative evaluation if surgery is being considered. Surgical decision-making is aided by assessing displacement on the AP view; however, this can be misleading as the deformity may occur in the AP plane and thus the true displacement will be masked by bony overlap. Advanced imaging of the clavicle such as CT scanning is rarely required, except in cases of medial clavicle fracture or dislocation, or to evaluate for associated fractures in the shoulder girdle. However, in elderly trauma patients who often receive a chest CT in the emergency department, the scan should be carefully scrutinized for a clavicle fracture, as these are a prognostic marker for increased mortality in the geriatric population.

Zobacz więcej