Bipolar clavicular fractures and treatment options

Abstract

Introduction Fractures of the clavicle are common injuries, accounting 2.6-4% of all fractures in adults. Of these fractures, 21-28% are lateral clavicle fractures and 2-3% are medial clavicle fractures. Bipolar clavicle fractures are defined as a lateral and medial fracture and are uncommon. There is no consensus on the treatment of these fractures. The aim of this study is to provide a treatment on bipolar clavicle fractures based on the current literature. Methods The electronic databases PubMed, the Cochrane library and EMBASE were searched up on September 25th, 2017. Two reviewers (KR and TG) independently screened titles and abstracts for their relevance. Studies designed to evaluate the outcomes of conservative and/or operative treatment of segmental bipolar clavicle fractures in adults (> 16 years) were included. Editorials and commentaries were excluded, as well as synthetic, cadaveric and animal studies. Primary outcomes considered were pain reduction and shoulder function. Secondary outcomes considered are complications. Results Ten studies reporting results from ten patients were included for the review. In most patients, if treated operatively, surgical treatment with the use of double plating was performed. Only in elderly patients conservative treatment was adopted. All included patients were pain free and had a full range of motion after 3-6 months. Only two case reports provided a DASH score, while in eight studies no functional outcome score was measured. Conclusion A missed bipolar fracture can complicate the clinical progress. Surgical management of these fractures may be necessary; however, the treatment of choice depends on the age of the patient, daily activities and comorbidity.

Segmental clavicle fracture following a road bike injury

“…1 5 With a clinical concern but unclear plain radiography findings, CT scan of the clavicle may be ordered to further evaluate for subtle fractures or for surgical planning. 5 The teaching point in this case is that while the midshaft fracture garners attention, it is the lateral third fracture which is most concerning. While midshaft fractures historically have often been treated conservatively, the literature increasingly indicates that lateral clavicle fractures may benefit from surgical stabilisation.…”

“…Due to its anatomic location and supporting structures, the midshaft is the most commonly fractured portion of the clavicle 2. Rarely, there are reports of segmental fractures of the clavicle, where two or more portions of the clavicle are fractured simultaneously 1 3–10. A subset of segmental fractures that involve the medial and lateral clavicle are labelled as bipolar segmental fractures 3 5 7.…”

“…Rarely, there are reports of segmental fractures of the clavicle, where two or more portions of the clavicle are fractured simultaneously 1 3–10. A subset of segmental fractures that involve the medial and lateral clavicle are labelled as bipolar segmental fractures 3 5 7. One study found that segmental fractures made up 0.8% of all clavicle fractures 9.…”

“…History taking should be directed towards questions concerning self-defence or high-impact trauma. Because midshaft clavicle fractures are common, associated medial and lateral portions of a segmental clavicle fractures may be missed 1 5. With a clinical concern but unclear plain radiography findings, CT scan of the clavicle may be ordered to further evaluate for subtle fractures or for surgical planning 5…”

“…The teaching point in this case is that while the midshaft fracture garners attention, it is the lateral third fracture which is most concerning. While midshaft fractures historically have often been treated conservatively, the literature increasingly indicates that lateral clavicle fractures may benefit from surgical stabilisation 1 3 5 7 8 10 11…”