To characterize the fracture pattern and pattern of fragmentation for displaced, mid-shaft clavicle fractures undergoing operative management.
Prospective observational study.
Two institution. Level 1 and Level 2 Trauma Centers.
Patients/Participants: Fifty-three patients who underwent operative repair of midshaft clavicle fracture.
All clavicles were treated by operatively open reduction internal fixation.
Main Outcome Measurements:
All clavicles were categorized by the Robinson classification based on injury plain film bilateral upright clavicle radiographs. Additionally, intra-operative fracture characteristic of fragment length and location were measured and recorded to evaluate fracture pattern. All fractures were analyzed to determine frequency of segmental comminution versus length-stable patterns, analyze characteristics of butterfly fragment size, number and location as well as the location of the cortical read for those length-stable fractures.
Analysis revealed 55% were Robinson 2B2 based on pre-operative radiographs. Length-stable, anatomic reduction was achievable in 83%. For those in which an anatomic cortical read was achievable, 97.7% had a read present in the posterior-superior aspect of the clavicle.
Midshaft clavicle fractures that meet conventional criteria for operative repair occur in a predictable manner with butterfly fragments generated from compression anterior-inferiorly and simple fracture line generated from tension along the posterior superior aspect of the clavicle. Understanding this pattern can assist in the in surgical planning.