What is the diagnosis for a patient with a displaced mid-clavicular (collarbone) fracture and inferior displacement of the distal clavicular segment, accompanied by an anterior-inferior dislocation of the humeral head relative to the glenoid?

From the Guidelines

The patient's condition is best described as a displaced mid-clavicular fracture with inferior displacement of the distal clavicular segment, accompanied by an anterior-inferior dislocation of the humeral head relative to the glenoid, which is a complex injury requiring prompt orthopedic consultation for proper management. The diagnosis of this condition involves identifying the extent of the clavicle fracture and the shoulder dislocation, which can be achieved through X-rays and possibly a CT scan for better visualization of the fracture fragments and the dislocation 1. Given the severity of the displacement and the potential for malunion or nonunion, surgical treatment of the displaced clavicle fracture is likely the best option, as it results in equivalent or improved short-term patient-reported outcomes and reduced rates of nonunion or symptomatic malunion compared to nonsurgical treatment 1. Key considerations in the management of this patient include:

• Prompt reduction of the shoulder dislocation under sedation to prevent further soft tissue damage
• Immobilization of the shoulder in a sling for 2-4 weeks to allow for initial healing
• Possible surgical fixation of the clavicle fracture, with techniques including plate osteosynthesis or intramedullary fixation, to achieve proper alignment and stability
• Pain management with acetaminophen and NSAIDs, if not contraindicated, and the use of ice for the first 48-72 hours
• Further imaging, such as MRI, to assess for potential soft tissue damage, including rotator cuff tears or labral injuries, once initial management is underway
• Physical therapy for rehabilitation, starting with passive range of motion exercises followed by strengthening, to restore function and strength to the shoulder complex.

From the Research

Diagnosis of Displaced Mid-Clavicular Fracture with Concomitant Shoulder Injury

The diagnosis for a patient with a displaced mid-clavicular (collarbone) fracture and inferior displacement of the distal clavicular segment, accompanied by an anterior-inferior dislocation of the humeral head relative to the glenoid, can be complex and requires careful evaluation.

• The patient's condition involves a combination of a clavicle fracture and a shoulder dislocation, which can be classified and treated based on the severity and type of injury.
• Studies have shown that operative treatment, such as open reduction and internal fixation (ORIF), can lead to improved short-term functional outcomes and increased patient satisfaction compared to conservative treatment 2, 3, 4, 5.
• The optimal treatment strategy should be tailored to the patient's specific needs and expectations, taking into account the severity of the injury, the patient's age, and their level of physical activity 5.
• In cases where the clavicle fracture is accompanied by a high-grade acromioclavicular joint dislocation, operative management using a dual plating technique may be necessary to reduce the risk of non-union and achieve full range of motion 6.

Classification and Treatment of Clavicle Fractures

• Clavicle fractures can be classified based on the location and severity of the fracture, with mid-shaft fractures being the most common type 3, 4.
• Treatment options for clavicle fractures include conservative management with a figure-of-eight bandage and sling, as well as operative treatment with plate fixation or intramedullary nailing 3, 4.
• The choice of treatment depends on the severity of the fracture, the patient's age, and their level of physical activity, with operative treatment generally recommended for displaced and comminuted fractures 3, 4, 5.

Complications and Outcomes

• Complications of clavicle fractures can include non-union, malunion, and adhesive capsulitis or stiffness, with operative treatment associated with an increased risk of complications and re-operations 2, 3, 4, 5.
• However, operative treatment can also lead to improved functional outcomes, increased patient satisfaction, and an earlier return to sports and activities 2, 3, 4, 5.
• Long-term shoulder functional outcomes are generally similar between operative and conservative treatment, highlighting the importance of careful evaluation and treatment planning for each individual patient 5.