Bilateral Displaced Midshaft Clavicle Fractures Following High-energy Road Traffic Trauma: A Case Report and Review of the Literature.

BackgroundAlthough clavicle fractures are common injuries in adults, simultaneous bilateral clavicle fractures are rarely reported. The present report describes 13 patients with simultaneous bilateral traumatic clavicle fractures who were treated with surgical management and followed for more than 12 months postoperatively.MethodsThis retrospective chart review involved skeletally mature patients with traumatic clavicle injuries. Patients with bilateral clavicle fractures who were followed up for at least 12 months after surgery were included. Data regarding the patients’ demographics, injury characteristics, fracture classification, comorbidities, concomitant injuries, and treatment strategies were collected. Each displaced fracture was managed with open reduction and internal fixation. Postoperative follow-up included radiographs for assessment of bone union; calculation of the Constant–Murley score for shoulder function; administration of the Disability of the Arm, Shoulder, and Hand questionnaire for upper limb function; determination of the visual analogue scale score for pain; and assessment of complications.ResultsFrom 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%). Of these 15 patients, this study included 13 patients (8 men, 5 women; mean age, 38.3 ± 15.3 years) who were followed up for more than 12 months postoperatively. Among the 13 patients, 10 (77.0%) had associated concomitant injuries, and 25 sides were fixed with internal plate fixation. After a follow-up period of 29.9 ± 28.5 months, all fractures achieved bone healing. Eleven patients attained excellent shoulder function on both sides and returned to their pre-injury daily activities, and the remaining two patients had unilateral shoulder dysfunction. No complications occurred.ConclusionsBilateral clavicle fractures are extremely rare and associated with polytrauma. Open reduction and internal fixation is recommended for such patients, especially those with severe chest injuries, because osteosynthesis of the clavicle can improve respiratory function and reduce the duration of functional disability.

Bilateral clavicle fractures are rare, with an overall incidence of 0.43%. Various treatment methods exist, but no consensus has been reached. We report a case of a 51-year-old male patient with bilateral midshaft clavicle fractures treated with minimally invasive Osteosynthesis. After 14 months of follow-up, bone healing and functional recovery were excellent. In conclusion, minimally invasive fixation is a viable alternative treatment for this fracture type, complementing established methods. The selection of a suitable minimally invasive fixation device should be individualized for each fracture type.

Bilateral clavicle fractures are a rare injury and rarely reported in the literatures. Bilateral clavicle fractures account for only 0.5% of all the clavicle fractures. In total it represents only 0.011 to 0.017 of all fractures. It is usually caused by a high velocity injury which is often accompanied by chest injuries. It is caused by direct trauma to one clavicle followed by the other or by a compression injury across both shoulder girdles. The mechanism of injury is different in both cases. Combination of mid shaft fracture on one side and lateral end on another side is very rare. A 36 -year -old male met with a road traffic accident and was brought to emergency department. He was having swelling and tenderness in bilateral clavicle and chest compression was negative. The shoulder range of movements was restricted on both sides. X ray of the chest with bilateral clavicles were done. It showed comminuted midshaft clavicle fracture on the right side and displaced lateral end fracture of clavicle on the left side without obvious rib fractures. All the routine investigations needed for anesthetic fitness were done and planned for open reduction and internal fixation with plating. Mid shaft fracture on right side fixed with clavicle locking plate and a lag screw. The lateral end fracture fixed with clavicle plate in same sitting under general anesthesia. The surgical fixation using low profile anatomical locking plates helped in the early mobilization of the affected limb compared to conservative treatment which requires prolonged immobilization. The upper limbs were immobilized for 2 weeks post operatively and all movements except abduction and overhead movements were started. He gained full range of movements at 6 weeks post operatively. Bilateral clavicle fractures as such are not an indication for surgery but suggested that it is surgically fixed to minimize the duration of functional disability. Surgical option for bilateral clavicle fractures gives excellent outcome in terms of early rehabilitation.

Bilateral medial third clavicle fractures are very rare, with only very few cases reported in the literature. The mechanism underlying this type of fracture is often complex, and so far, its treatment remains controversial. We report a case of bilateral medial third clavicle fractures after a traffic accident. X-ray showed dislocation of bilateral medial third clavicles. The patient was cured by surgery and instrument fixation. Both clavicles were fixed using an inverted anatomic locking plate. The patient had excellent shoulder function after 2 years of surgery. Clavicle stability is necessary for normal shoulder function, and surgical fixation is becoming a trend for displaced medial third clavicle fractures. In this study, we reported a patient with bilateral clavicle fractures of the medial third who was treated by surgery and achieved excellent shoulder movement. An inverted anatomic locking plate is an effective internal fixation material for treating this type of fracture.

BackgroundSevere chest wall injuries are potentially life-threatening injuries which require a standardized multidisciplinary management strategy for prevention of posttraumatic complications and adverse outcome.Case presentationWe report the successful management of a 55-year old man who sustained a complete “bony disruption” of the thoracic cage secondary to an “all-terrain vehicle” roll-over accident. The injury pattern consisted of a bilateral “flail chest” with serial segmental rib fractures, bilateral hemo-pneumothoraces and pulmonary contusions, bilateral midshaft clavicle fractures, a displaced transverse sternum fracture with significant diastasis, and an unstable T9 hyperextension injury. After initial life-saving procedures, the chest wall injuries were sequentially stabilized by surgical fixation of bilateral clavicle fractures, locked plating of the displaced sternal fracture, and a two-level anterior spine fixation of the T9 hyperextension injury. The patient had an excellent radiological and physiological outcome at 6 months post injury.ConclusionSevere chest wall trauma with a complete “bony disruption” of the thoracic cage represents a rare, but detrimental injury pattern. Multidisciplinary management with a staged timing for addressing each of the critical injuries, represents the ideal approach for an excellent long-term outcome.

Clavicle fractures have been known to be common injuries with a reported incidence of 2.4-4% amongst all fractures, however the incidence of bilateral clavicle fractures is rare. A thorough search of all English language journals revealed that bilateral clavicle fractures comprised 0.43% of all clavicle fractures, with an overall incidence of between 0.011-0.017%. Though the surgical intervention of clavicle fractures uses many implants, never has been screw intramedullary flexible nail been used in a bilateral clavicle fracture. We report a case of a 32-year-old male who presented with bilateral clavicle fracture and was treated successfully.

Clavicle fractures are among the most common fractures in adults. Bilateral clavicle fractures are uncommon injuries and are rarely reported in literature. Most of the studies prefer surgical management over conservative for bilateral clavicle fractures to achieve better functional outcome and early rehabilitation. We present a rare case of 68 year old female with bilateral clavicle fractures was treated non operatively. The follow up of this patient showed good functional outcome with full range of shoulder movements on either side and pain free.

Bilateral clavicle fractures are uncommonly reported in the literature with the incidence being less than 0.5% of all the clavicle fractures. Bilateral clavicle fractures are caused either by high-energy transfer of compression forces across both shoulder girdles or by a direct trauma to one clavicle followed by that to the other clavicle. These fractures could be missed due to their association with more severe chest injuries or a more symptomatically displaced fracture on one side or due to inadequate chest radiographs. We report three cases of traumatic bilateral clavicle fractures with three modes of injuries in different age groups. All the fractures were treated conservatively with good functional outcomes without any sequelae. Bilateral clavicle fractures should be actively sought by every trauma team with proper clinical examination and chest radiographs including both shoulder joints in high-energy trauma cases or with bilateral shoulder compression injuries.

Clavicle fracture is one of common injuries in young adult and fracture in the middle third is the most common injury cases in clavicle fractures. Although clavicle fractures are often seen, in some circumstances bilateral clavicle fractures can occur due to high-energy impact injury, but this is an extremely rare and seldom reported on. Clavicle fracture is not commonly mentioned as an indication for operative intervention, but in cases of bilateral clavicle fracture surgical intervention managed to limit the duration of functional disability and allowing for an earlier functional recovery.

Background: Fracture clavicle is a common fracture around the shoulder joint accounting about 2.6% of all fracture and 44% in shoulder region. Mid shaft clavicle fracture accounts about 81% of total clavicle fracture. Open reduction and plate fixation is a good treatment method for displaced mid shaft clavicle fracture with benefit of early pain free movement of shoulder joint and early return to work. The anatomical contoured clavicular plate maintains mechanical strength and has less soft tissue complications.
 Aims and Objective: The aim of the study was to evaluate the clinical and radiological outcome, time for fracture union and complications in midshaft clavicle fracture managed with anatomical contoured clavicularlocking plate. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal.There were a total of 30 patients (19 male and 11 female) who had displaced mid shaft fracture. All patients underwent plate osteosynthesis with anatomical contoured locking plate. The patients were followed up at 3 weeks, 6 weeks, 3 month and 6 months’ time.
 Results: There were 30 patients among whom; one patient had bilateral clavicle fracture. The mean age of the patient was 37.19 (11.96) years. The mean time for clinical and radiological union was 8.77 (1.17) weeks and 17.03 (3.06) weeks. All patients in our study had union of fracture with only one patient having superficial surgical site infection.
 Conclusion: Open reduction and plate fixation is a good option for displaced mid shaft clavicle fracture which help the patient for early pain-free movement of shoulder. Use of anatomical contoured clavicle plate provides fixation of clavicle to its normal contour and provides better fixation and stability.

Bilateral and open fractures of the clavicle are rare injuries, with Gustilo-Anderson Type III open clavicle fractures rarely seen. We have reported a case of bilateral clavicle fractures in a young male with crush injury of the neck on the right side, multiple associated rib fractures, and brachial plexus injury. The crush neck was managed with extensive debridement and clavicle fractures were managed with external fixation with a supracutaneous locking compression plate on the right side, and internal fixation with a reconstruction plate on the left side. The wound healed with serial negative-pressure dressings without any secondary procedure. Both the fractures united well with a good outcome. This case demonstrates the effective use of negative-pressure wound therapy and supracutaneous locked plating for a Gustilo-Anderson Type IIIB open fracture of the clavicle.

Bilateral clavicle fractures are considered rare. Most of the cases are caused by high energy traumas, such as automobile accidents. Such fracture is related to a higher frequency and severity of associated lesions. In this report, the authors present a twenty-two-year-old male patient's case who, after a motorcycle collision, suffered a bilateral medial end clavicle closed fracture, developing asymptomatic bilateral pseudoarthrosis after the patient refuses surgical treatment. The presented case is quite rare. Aspect related to the patient's evolution during treatment will be discussed, plus the fracture mechanism, associated injuries, the bilateral clavicular fractures treatment, and management in cases of pseudoarthrosis will be analyzed.

Double-plate fixation in double clavicle fractures: A case report

Clavicle fractures historically have been managed without internal fixation. Current literature is raising questions regarding this management as opposed to offering operative fixation in some instances. This study addresses the use of the Disabilities of the Arm, Shoulder and Hand (DASH) outcomes measure to identify those that have the least satisfaction with nonoperative care of the clavicle fracture based upon clavicular deformity and variation in fracture location based upon Allman Classification. Patients having suffered clavicle fractures were mailed the DASH Outcomes Questionnaire to be completed and returned. A total of 113 surveys were returned completed with 92 being of value for evaluation. Patient chest or clavicle radiographs were evaluated, and measurements were made of the clavicle fractures for amount of separation or shortening and grade according to Allman Classification. Statistical evaluation compared DASH Scores (patient satisfaction as outcome measure) to the Allman Classification and the degree of separation or shortening. Comparison of categorical variables was performed using Fisher's exact test. Comparison of continuous variables was preformed using Student's t test. Statistical significance was demonstrated by a p value of less than 0.05. Patients with clavicular shortening of greater than 2 cm were found to have the highest DASH score indicating dissatisfaction and disability with their outcome postinjury (p = 0.0001). Separation or lengthening seemed to be associated with lower DASH Scores. Patients with Allmen Classification I (midshaft clavicle) fractures had higher DASH score than other fracture locations (p = 0.0001). Patients with midshaft clavicle fractures with shortening of greater than 2 cm may be good candidates for operative repair given the degree of dissatisfaction with nonoperative management of these fractures as assessed by long-term outcome measures of disability.

Bilateral clavicle fractures are uncommon and are mostly associated with polytrauma. The presence of concurrent serious injuries diverts the doctor's attention and causes the clavicular injury to be overlooked. Our report presents a 39‐year‐old male patient with bilateral clavicle fracture whom we managed surgically by open reduction and internal fixation.