The clavicle may be fractured by direct or indirect violence, or either end of the bone may be dislocated. The early ossification of the clavicle accounts for its frequency in children, and the sterno-clavicular ligaments explain the rarity of separation of the single clavicular epiphysis situated at the inner end of the bone. Dislocation of either end of the clavicle is rare as compared with fracture. Males are more subject to injury of this bone and its articulations because of their occupations, and heavier musculature. The coraco-clavicular ligaments are an important element in determining the site of fracture when due to indirect violence, and in limiting the displacement in both fractures and dislocations. The stability of either end of the clavicle depends on ligaments, rather than the conformation of the articular surfaces. The acromial end is dislocated nearly four times as often as is the sternal end, while all the dislocations of the clavicle make up about four percent of the luxations of the entire body. Dislocations of both ends of the bone, and simultaneous dislocations of both clavicles, are conditions which have been recorded, though they are extremely rare.
Injuries to the clavicle and its articulations will be taken up in the following order:
- Dislocation of the sternal end: Forward. Backward. Upward.
- Fracture of the clavicle.
- Dislocation of the acromial end: Upward. Downward. Sub-coracoid.
<Callout type="important" title="Critical Rule">A systematic examination of the entire region should be made in addition to determining the condition of the bone in question.</Callout>
The fact should never be lost sight of that two or more lesions may be present at the same time. The surgeon should remember that the examination is not necessarily concluded with the finding of a given lesion; further damage may have been done to adjoining bones or joints. Particularly, care should be exercised in examining children because of the mild and indefinite character of the symptoms accompanying the fracture of the clavicle in the early years of life.
Key Takeaways
- The stability of either end of the clavicle depends on ligaments, not the conformation of articular surfaces.
- Dislocation of the sternal end is rare compared to fractures.
- Care should be exercised in examining children due to mild symptoms.
Practical Tips
- Always perform a thorough examination when treating upper extremity injuries to ensure no additional damage has been done.
- Be aware that multiple lesions may coexist, so do not limit your assessment to just the primary injury.
- In cases of clavicle fractures in children, be cautious as symptoms can be subtle and easily overlooked.
Warnings & Risks
Risk of Missed Lesions
Two or more lesions may be present at the same time, so a comprehensive examination is crucial.
Children's symptoms can be mild and indefinite, making it easy to miss fractures if not properly examined. - Carelessness in examining children could lead to underestimating the severity of injuries.
Modern Application
While the specific techniques described may differ from modern medical practices, understanding the basic principles of clavicle fractures and dislocations remains crucial for survival preparedness. Modern first aid kits should include splints and bandages that can be used similarly to those mentioned in this chapter, ensuring proper immobilization and support until professional help is available.
Frequently Asked Questions
Q: How common are dislocations of the clavicle compared to fractures?
Dislocation of either end of the clavicle is rare as compared with fracture. The chapter notes that all the dislocations of the clavicle make up about four percent of the luxations of the entire body, indicating their relative rarity.
Q: What should a surgeon do if they find a lesion during an examination?
The chapter advises that further damage may have been done to adjoining bones or joints. Therefore, it is important for the surgeon not to conclude the examination with just one finding and to continue checking the entire region.
Q: Why are males more susceptible to clavicle injuries?
Males are more subject to injury of this bone and its articulations because of their occupations, and heavier musculature. This suggests that physical labor or activities involving heavy lifting or impact may increase the risk.