Management Of Clavicle Fractures Research Articles

Surgical Management of Clavicle Fracture with Precontoured Locking Plate

Surgical Management of Clavicle Fracture with Precontoured Locking Plate

Using a Nice knot to simplify and strengthen closed reduction in displaced distal clavicle fracture: a technical note.

A displaced distal clavicle fracture often necessitates surgical intervention, with various open and closed reduction options. Open reduction is easier but raises blood supply concerns, while closed reduction can involve complex deforming forces with differing displacement vectors. Herein, we demonstrate how a Nice knot with its sliding and self-locking qualities can be used to make closed reduction easier and the alignment more secure. A case report illustrates this Nice knot application in a 61-year-old male with a distal clavicle fracture. The Nice knot's ability to be loosened and retightened ensured more precise alignment in this case. The Nice knot technique is a versatile option for easier and more secure distal clavicle fracture management.

Navigating challenges: a case report on complications in clavicle fracture management with 'K' wire fixation

Orthopaedic metallic pins and wires are commonly used for the fixation of fractures and dislocations, with the shoulder girdle being one of the common areas for their application. Despite recent precautionary measures, complications related to migration of these devices into the pleural cavity continue to be reported. We present a case of a Kirschner wire (K-wire) migration from a left clavicle fracture to the first rib, highlighting the importance of vigilance and immediate intervention in such cases. A 35-year-old female, previously operated for a left clavicle fracture using K-wire and tension band wiring, presented with left shoulder and chest pain eight years later. Radiological investigations revealed a broken K-wire in the pleural cavity, with one portion near the acromio-clavicular region and the other at the posterior aspect of the first rib. Surgical intervention was performed, involving the removal of the K-wire from the chest cavity and clavicle, with subsequent patient recovery. The migration of orthopaedic pins and wires into the chest cavity is a rare but well-documented complication. Previous reports have demonstrated severe consequences, including cardiovascular complications and fatalities. Theories explaining wire migration include muscle action, shoulder mobility, negative intrathoracic pressure during respiration, regional bone resorption, gravitational forces, and even capillary action. To minimize such complications, subcutaneous K-wire ends should be bent, and restraining devices should be used. Close clinical and radiographic follow-up is essential until the pins and wires are removed after achieving the therapeutic goal. In case of migration, prompt removal is necessary to prevent fatal complications. This case report emphasizes the significance of vigilance and proper precautions when using orthopaedic pins and wires for shoulder girdle fractures. Timely intervention is crucial to mitigate severe complications associated with migration. Sharing experiences and lessons learned can contribute to the safer application of these fixation devices in orthopaedic practice.

Do We Ever Need to Fix Clavicle Fractures in Adolescents?

Clavicle fractures in adults are increasingly being treated by surgical fixation following reports of symptomatic non-union, malunion and poor functional outcome with conservative treatment. This has led to a similar trend in the management of clavicle fractures in adolescents. This study aims to evaluate the outcome and complications of non-operatively treated clavicle fractures in adolescents. This is a retrospective, single institution study on adolescents aged 13-17 years who sustained a closed, isolated clavicle fracture, between 19972015. Clinical records were reviewed for demographic information, injury mode, time to radiographic fracture union, time to re-attainment of full shoulder range of motion (ROM), and time to return to full activities and sports. Complications and fracture-related issues were recorded. Radiographs were analysed for fracture location, displacement and shortening. A total of 115 patients (98 males, 17 females; mean age:13.9 ± 0.89 years) were included for study. 101 (88%) sustained a middle-third fracture while the remainder sustained a lateral-third fracture. A total of 96 (95%) of the middle-third fractures were displaced, and 12 (86%) of the lateral-third fractures were displaced. All displaced fractures in this study had shortening. Sports-related injuries and falls accounted for 68 (59%) and 34 (30%) of the cases respectively. Overall, the mean time to radiographic fracture union was 7.8 ± 4.35 weeks; there were no cases of non-union. Full shoulder ROM was re-attained in 6.6 ± 3.61 weeks, and full activities and sports was resumed in 11.4 ± 4.69 weeks. There were 5 cases of re-fracture and a single case of intermittent fracture site pain. Clavicle fractures in adolescents can and should be treated non-operatively in the first instance with the expectation of good outcomes in terms of time for fracture union, reattainment of shoulder full range of motion, and return to activities. Surgical stabilisation should be reserved for cases for which there is an absolute indication.

Clavicle fractures - epidemiology, biomechanics of injury and treatment methods

Introduction and purpose: The aim of this study is to to review and analyze scientific research on the topic of clavicle fractures, including epidemiology and comparison of the current conservative and surgical treatment options.
 State of Knowledge: Due to its structure and function as a support for the upper limb, the clavicle is one of the most frequently fractured bones in the human body. Any significant force acting on the shoulder, such as direct trauma or a fall onto an outstretched hand, can result in high stress forces, leading to a clavicle fracture. Depending on the location of the fracture, muscles pull the bone fragments in their respective directions, which affects the treatment approach for each type of fracture.To facilitate the choice of treatment method, classifications such as the Neer classification and the Edinburgh classification have been developed. Various surgical techniques as well as conservative treatments have been employed in the management of clavicle fractures.
 Conclusions: The epidemiology of clavicle fractures shows a higher incidence in young males, particularly related to sports activities. The majority of fractures occur in the middle third of the clavicle, with fractures in the distal and proximal thirds being less common. Understanding the ligamentous connections of the clavicle is crucial for understanding fracture patterns. There is no single preferred method of treatment, therefore both conservative and surgical methods are used in the therapeutic process depending on the fracture type. The functional outcome of various surgical techniques is similar.

Evidence-based management of clavicle fractures

Clavicle fractures account for approximately 2.6% of all fractures. Non-union following a clavicle fracture is associated with morbidity. The management of clavicle fractures, specifically operative and non-operative, has been debated. This article aims to provide clear, evidence-based guidance to direct clinical decision-making.

Surgical management of clavicle fractures in Australia: an analysis of Australian Medicare Benefits Schedule database from 2001 to 2020.

There is no consensus on the optimal management of clavicle fractures, with advocates of both operative and non-operative management. The objective of this study is to assess the trends in the management of clavicle fractures in Australia over the past two decades. The incidence of surgical fixation of clavicle fractures from 2001 to 2020 was analysed using the Australian Medicare Benefits Schedule database, reflective of operations performed on privately insured patients, thus excluding public patients and compensable cases. An offset term was utilized with data from the Australian Bureau of Statistics to account for population changes over the study period. A total of 17 089 procedures for the management of clavicle fractures were performed from 2001 to 2020. The incidence of operative intervention increased from 1.87 per 100 000 in 2001 to a peak of 6.63 per 100 000 in 2016. An overall increase was seen in males (310%) and females (347%) over the study period, as well as across all age groups. A greater proportion of operative interventions was performed on males (n= 14 075, 82%) than females (n= 3014, 18%, P< 0.001). The greatest increase in intervention was noted in those aged 65 or older (14% increase per year, 95% CI 11%-17%, P< 0.05). In 2020, the incidence of operative intervention decreased to a level last seen in 2013. The incidence of operative interventions for clavicle fractures has increased in Australia over the 20-year study period. This increase is in keeping with recent evidence suggesting several advantages when displaced mid-shaft clavicle fractures are operatively managed.

Assessing the Change in Operative Treatment Rates for Acute Midshaft Clavicle Fractures: Incorporation of Evidence-Based Surgery Results in Orthopaedic Practice.

This retrospective cohort analysis used population-level administrative health data on the residents of British Columbia, Canada. Cases were identified by International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes and procedure fee codes. Adult patients (≥18 years) with closed middle-third clavicle fractures between 1997 and 2018 were included. Multivariable logistic regression modeling compared the proportion of clavicle fractures treated operatively before and after January 1, 2007, controlling for patient factors. The Pearson chi-square test compared the proportion of fractures treated operatively for malunion or nonunion in the cohorts. A total of 52,916 patients were included (mean age, 47.5 years; 65.6% male). More clavicle fractures were treated operatively from 2007 onward: 6.9% compared with 2.2% prior to 2007 (odds ratio [OR] = 3.35, 95% confidence interval [CI] = 3.03 to 3.70, p < 0.001). Male sex, moderate-to-high income, and younger age were associated with a greater proportion of operative fixation. The rate of surgery for clavicle malunion or nonunion also increased over this time period (to 4.1% from 3.4%, OR = 1.26, 95% CI = 1.15 to 1.38, p < 0.001). We found a significant change in surgeon practice regarding operative management of clavicle fractures following the publication of a Level-I RCT. With limited high-quality trials comparing operative and nonoperative management, it is important that clinicians, health-care institutions, and health-authority administrations determine what steps can be taken to increase responsiveness to new clinical studies and evidence-based guidelines. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A Comparative Analysis of Plating versus Clavicle Pin in the Management of Clavicle Fracture

To compare plating versus clavicle pin in the management of clavicle fracture. Eighty- four adult patient in age ranged 24- 60 years of either gender with mid-shaft clavicle fracture were randomly divided into 2 groups of 42 each. Group I patients were treated with clavicle pins and group II with plating. Parameters such as ASES score subjective, objective, constant score subjective, objective and complications of each method was recorded. There were 22 males and 20 females in group I and 24 males and 18 females in group II. ASES score subjective pain value found to be 9.8 in group I and 9.0 in group II. Activity score found to be 29.7 in group I and 28.3 in group II. ASES score objective range of motion found to be 40 in group I and 39.2 in group II. Strength was 20 each in both groups. Constant score subjective was 34.4 in group I and 32.1 in group II. Constant score objective was 63.5 in group I and 61.9 in group II. A significant difference was observed (P&lt; 0.05). Result of the study demonstrated that clavicle pinning resulted in excellent functional outcomes.

Surgical Fixation of Clavicle Shaft Fractures Using Superior Locking Plates With Lateral End Extension: A Retrospective Study.

Background Reports of high rates of non-union with poor functional outcomes following non-operative management of clavicle fractures have resulted in a shift of opinion towards the promising outcomes of surgical fixation. Varied implant choices with varying reports of successand associated complications have resulted in no definitive consensus on the choice of the ideal implant. Materials and Methods This is a retrospective study of clavicle shaft fractures stabilized using a Superior Clavicle Locking plate with lateral extensionin 40 active adult patients, predominantly male, with an average age of 36.7 years. Results Post-operatively, early mobilization was initiatedand on final discharge, there were no complaints of pain. All patients returned to their pre-injury levels of activity by four months, with all having achieved, essentially, a full range of movement by eight weeks post-operatively. Radiological union was observed in all patients by 5 months, except one. The QuickDASH scores of all the patients were less than 25 on discharge. Conclusion When surgical stabilization is considered in the management of active adults with clavicle shaft fractures, the superior clavicle locking plate with lateral extension appears to be a suitable implant by providing stable fixation lateral to the fracture, which is difficult with a regular locking plate.

Management of Clavicle Midshaft Fractures: A Comparative Prospective Study in Jammu

Background: Clavicle fracture, which is also commonly known as a broken collarbone, occurs mostly due to direct high impact energy over the bone due to a fall onto the lateral shoulder or on the outstretched hand. It has been seen that such types of fractures are prevalent among active and sports persons due to sporting activities. This study aimed to assess the pros and cons associated with conservative and surgical management of clavicle fractures.&#x0D; Methods: The present prospective comparative study was conducted at Government Medical College Kathua between February 2021 to January 2022. There was a total of 52 patients, with 26 patients in each group. Group A patients were given conservative management, while Group B patients were operated on for plate fixation.&#x0D; Results: The average fracture union time in group A was slightly higher compared to group B (15.9 vs. 13) weeks. And the difference was statistically significant with a p-value of 0.0483. We observed that there exists a significant difference between the two groups with respect to the total score at 24 weeks (6 months). Evidently, the average CMS score for the conservative group is smaller compared to the operated group (89.95 vs. 94.2) weeks. However, the majority of patients in group A had malaunion complications (65.4%) compared to (3.8%) in group B, and the difference was statistically significant.&#x0D; Conclusion: Evidently, post six months of displaced midshaft clavicle fracture, the rate of complications was more prevalent in group A compared to group B.

Midshaft clavicle fractures: A review of current literature

Clavicle fractures are the most common fracture in the human body, accounting for 5–10% of all fractures presenting to the Emergency Department. The treatment of clavicle fractures historically has been more on the conservative side, but there has been recent evidence that operative management could reduce the incidence of adverse outcomes post-fracture. This review focuses on analysing the previous and present scientific literature on post-operative and post-conservative clavicle complications. This review concludes that the evidence for surgical management of clavicle fractures with certain indications is controversial and further studies are required.

Modified Clavipectoral Fascial Plane Block to The Rescue: Polytrauma Patient with Brachial Plexus Injury Undergoing Awake Clavicle Surgery

Modified Clavipectoral Fascial Plane Block to The Rescue: Polytrauma Patient with Brachial Plexus Injury Undergoing Awake Clavicle Surgery

Does operative management provide better outcome in displaced mid-shaft clavicle fractures? A randomized control study

Background: Mid-shaft clavicle fracture management has been inclined more toward osteosynthesis in recent times for better functional outcomes. The aim of the study was to find out does operative management in displaced mid-shaft clavicle fractures provide better outcomes than conservative? Materials and Methods: The randomized trial was conducted between December 2017 and July 2019 at a tertiary trauma center on 50 consecutive patients with displaced mid-shaft clavicle fracture. The inclusion criteria included age between 16 and 60 with acute isolated closed displaced mid-shaft clavicle fracture. Patients with neurovascular deficit, compound fractures, pathological fractures, and nonunion/malunited fractures were excluded. Group A had 25 patients who were treated with operative line of management and Group B had 25 patients who were treated with a conservative line of management; division was done on basis of odd (Group A)–even (Group B) technique. Results: Out of 50 patients, the mean age group of patients was 35.5 ± 1 years of life with others ranging from 16 to 60 years. Out of 50 patients, 45 (90%) patients were male and 5 (10%) were female. Out of 50 patients, 42 had a history of road traffic accidents, while 8 had a history of falls. The right side clavicle was affected in 18 patients and left was affected in 32 patients. Out of 50 patients, the mean time of union in operative group was 11.36 ± 2.56 and 11.36 ± 2.75 weeks in nonoperative group. Constant shoulder score was 85.16 ± 15.30 and 84.64 ± 13.52 in the operative group and nonoperative group, respectively. Conclusion: In this prospective cohort study, we have concluded that long-term functional outcomes of conservative versus operative management of displaced mid-shaft clavicle fracture are similar, but primary open reduction with internal fixation of displaced mid-shaft clavicle fracture in young adult patients ensures anatomical reduction, early mobilization, and faster recovery for functional activity while avoiding complications such as malunion.

Incisional paresthesia following clavicle plate fixation: does it matter to patients?

BackgroundOperative management of clavicle fractures is increasingly common. In the context of explaining the risks and benefits of surgery, understanding the impact of incisional numbness as it relates to the patient experience is key to shared decision making. This study aims to determine the prevalence, extent, and recovery of sensory changes associated with supraclavicular nerve injury after open reduction and plate internal fixation of middle or lateral clavicle shaft fractures.MethodsEighty-six patients were identified retrospectively and completed a patient experience survey assessing sensory symptoms, perceived post-operative function, and satisfaction. Correlations between demographic factors and outcomes, as well as subgroup analyses were completed to identify factors impacting patient satisfaction.ResultsNinety percent of patients experienced sensory changes post-operatively. Numbness was the most common symptom (64%) and complete resolution occurred in 32% of patients over an average of 19 months. Patients who experienced burning were less satisfied overall with the outcome of their surgery whereas those who were informed of the risk of sensory changes pre-operatively were more satisfied overall.ConclusionsPost-operative sensory disturbance is common. While most patients improve, some symptoms persist in the majority of patients without significant negative effects on satisfaction. Patients should always be advised of the risk of persistent sensory alterations around the surgical site to increase the likelihood of their satisfaction post-operatively.

The emergency medicine management of clavicle fractures

Clavicle fractures are common. An emergency physician needs to understand the diagnostic classifications of clavicle fractures, have a plan for immobilization, identify associated injuries, understand the difference between treating pediatric and adult patients, and have an approach to multimodal pain control. It is also important to understand when expert orthopedic consultation or referral is indicated. To provide an evidence-based review of clavicle fracture management in the emergency department. Clavicle fractures account for up to 4% of all fractures evaluated in the emergency department. They can be separated into midshaft, distal, and proximal fractures. They are also classified in terms of their degree of displacement, comminution and shortening. Emergent referral is indicated for open fractures, posteriorly displaced proximal fractures, and those with emergent associated injuries. Urgent referral is warranted for fractures with greater than 100% displacement, fractures with >2 cm of shortening, comminuted fractures, unstable distal fractures, and floating shoulder. Nondisplaced or minimally displaced fractures with no instability or associated neurovascular injury are managed non-operatively with a sling. Pediatric fractures are generally managed conservatively, with adolescents older than 9 years-old for girls and 12 years-old for boys being treated using algorithms that are similar to adults. When encountering a patient with a clavicle fracture in the emergency department the fracture pattern will help determine whether emergent consultation or urgent referral is indicated. Most patients can be discharged safely with sling immobilization and appropriate outpatient follow-up.

A prospective comparative study of surgical management verses conservative management of clavicle fracture

Background: Fracture of the clavicle accounts for 5 to 10% of all fractures and almost half of the shoulder girdle injuries and70- 80% of clavicular fractures are mid clavicular fractures. Most clavicular fractures are benign. Non operative treatment has been a mainstay of a modality of treatment, and irrespective of the type of fracture and amount of comminution, all these fractures were treated non-operatively. Different surgical methods for clavicle midshaft fractures have been described and these are locking compression plate fixation, intramedullary K-wires, Steinmann pin fixation, and intramedullary nailing with TENS. Therefore in this study we have compared the functional outcome of displaced clavicle fractures treated by non-surgical management with that of surgical management by TENS and by open reduction and internal fixation with clavicular locking compression plate. Methodology: 30 Patients of age above 18 years having closed clavicular fracture who are admitted in DR. B.R. Ambedkar Medical College and Hospital, meeting the inclusion criteria are taken for study after obtaining their written informed consent. Patients were followed up for a period of 6 months at 1,6 and 24 weeks after surgery. In total 15 patients were operated and 15 patients were treated conservatively. Outcome was analysed in terms of radiological union and functional outcome of the patient. Results: Among 30 patients with clavicle fractures, majority of the injury occurred in male patients- 21 cases (70%), whereas a total of 9 cases (30%) were seen in females. The functional outcome at the end of 6 months in 15 conservatively managed cases showed, 2 cases (13.3%) with excellent outcome, 3 cases (20%) had good outcome, 8 cases (53.3%) had fair and 2 cases (13.3%) had poor outcome. While in surgically managed 15 cases, the functional outcome at the end of 6months showed a total of 11(73.3%) cases with excellent outcome, 2 cases (13.3%) had good outcome, 1 cases (6.6%) had a fair, and 1case (6.67%) had poor outcome. At the end of 6 months, functional outcome of both the groups were compared and in our study operative group had fewer complications, early bony union and better functional outcome as compared to the conservative group. Conclusion: This study concludes that irrespective of surgical modalities of management used, surgically treated cases have better functional outcome, fewer complications, early bony union and better overall patient satisfaction.

Successful using of combined interscalene block and deep cervical plexus block for clavicle fracture in patients with impaired airway integrity due to combat injury

General anaesthesia has a priority in surgical interventions of clavicle; however, regional techniques may come to the fore in the presence of increased risk factors. The innervation of the clavicle region is very complex and has not been fully described; therefore, only a limited number of different regional anaesthesia approaches should be considered. Here, we present the management of a clavicle fracture with a combination of an interscalene block (ISB) and deep cervical plexus block (dCPB) in a patient with severe maxillo-facial trauma (MFT) and diaphragmatic hernia due to combat injury. A 35-year-old male admitted to the emergency room as a war-wounded patient had suffered MFT and an unstable clavicle defect during the Syrian War. A diaphragmatic hernia was also detected during examination. The patient underwent operation with regional anaesthesia of the clavicle under spontaneous respiration. With standard monitoring and sedation, ISB and dCPB were performed under ultrasound guidance with a mixture of 0.25% bupivacaine (20 mL) and 0.5% lidocaine (10 mL). In the perioperative period, the patient's vital signs remained stable. The patient had no pain during the surgery. We suggest that the combination of ISB and dCPB is an efficient option for management of clavicle fracture in patients with multiple comorbidities.

Operative Versus Non-Operative Treatment of Severely Shortened or Comminuted Clavicle Fractures in Older Adolescent Athletes: Results from A Prospective, Multicenter, Level 2 Cohort Study

Objectives:Operative management of clavicle fractures is increasingly advocated for athletes and young adults. Surgical indications and optimal treatment for comminuted or severely shortened clavicle fractures in adolescent athletes remain unclear. The purpose of this study was to evaluate the outcomes of non-operatively and operatively treated comminuted and/or severely shortened (>25mm) clavicle fractures in older adolescent athletes.Methods:Athletes aged 14 to 18 years with mid-shaft clavicle fractures who had non-operative (NONOP) or operative (OP) treatment at one of eight participating centers between 2013 and 2017 were screened for the presence of comminution and/or fracture shortening >25mm. Demographics, injury mechanism, fracture characteristics and treatment (NONOP vs. OP) were prospectively recorded and patients followed for a minimum of two years. Complications, rates and timing of return to sport (RTS), and patient reported outcomes (PROs: ASES, QuickDASH, MARX shoulder activity, EQ-5D, EQ-VAS, and patient satisfaction) were analyzed.Results:The two groups included 137 patients (70 NONOP, 67 OP), with a similar distribution among various sports—most commonly football—and rates of competitive athletic participation (NONOP: 81%, OP: 85%) (Figure 1). Of the 137 patients, 100 [NONOP n=52, 15.3 years, 44 males (84.6%); OP n= 48, 15.5 years, 40 males (83.3%)] provided PROs at > 2 years. Comminution (C) and shortening (S) were not different between groups [NONOP C=24 (46.2%), S=28mm (24.5, 33.2); OP C=35 (72.9%), S=28mm (25.0, 36.5)], but the OP group demonstrated 3 mm greater vertical displacement [NONOP 13.0 (9.6, 18.0) mm, OP 16.0 (11.8, 21.0) mm; p<0.05], which was therefore controlled for as a statistical confounder in the comparative PRO analysis. There was no difference in nonunion, delayed union, symptomatic malunion, re-fracture, or clinically significant complications between treatment groups (Table 1). Two years after injury, 75% of NONOP and 79% of OP patients reported RTS, with 61% and 57%, respectively, reporting achievement of same sport-level and similar RTS timing (OP=10 weeks, NONOP= 11.6 weeks). When controlling for minor differences in superior displacement, regression and matching analyses demonstrated no difference in mean and dichotomized PRO scores between the NONOP and OP groups (Table 2).Conclusions:In this prospective multi-center cohort of comminuted and/or severely shortened (>25mm) clavicle fractures in adolescent athletes, there was no difference in complications, RTS, or PROs between non-operatively and operatively treated patients at 2 years. Despite several studies suggesting the contrary in adult populations, comparably excellent outcomes of severe clavicle fractures in adolescent athletes can be achieved with non-operative treatment.

Comparative Study of Conservative Vs Surgical Management of Clavicle Fractures

Background: Clavicle Fractures is one of the common fractures of upper limb accounting for approximately 40 % of all shoulder fractures. Till recently all clavicle fracture were treated conservatively, but now interest in surgical management is rising. This study was carried out to see if Surgical management outweighs the conservative treatment of Fractures Of Clavicle. Methods: A total of 40 cases satisfying inclusion and exclusion criteria were included in the study. Alternate patients were allocated to operative and conservation groups. In total 20 patients were operated operatively and 20 patients were treated conservatively. Outcome was analysed in terms of radiological union and functional outcome of the patient. Constant and Murley score was used as a score to evaluate final outcome. Results: In this study, the 20 patients who were operated upon had an average union time of 7.8 weeks; 1 patient had delayed fracture union by 12 wks. 20 patients in conservative group had normal union of fractures with 1 patient going into non-union. Average union time in the conservative group was 9.4 weeks, which was more than the 7.8 weeks seen in the group treated operatively. Mal-union was present in 7 of the 20 patients treated conservatively, and 5 of these 7 had a visible deformity. Out of these patients with mal-union 1 had poor functional outcome, 3 had good to excellent outcome and 3 had satisfactory functional outcome. 4 of these had restricted movements terminally and 2 had pain on movement. Conclusions: From our study based on patients of clavicle fractures, it can be concluded that the operative group had significantly higher excellent outcomes as compared to the conservatively- managed group, based on the Constant and Murley score. Keywords: Clavicle Fractures, Constant and Murley Score, Operative Clavicle Fracture Management, Clavicle Fracture Functional Outcome.