Fractures of the medial end of the clavicle

Much is known regarding the epidemiology of clavicle fractures, particularly those of the middle-third and distal clavicle. Medial clavicle fractures are uncommon, and as a result, there is little information available. The purpose of this study is to review retrospectively a case series of medial clavicle fractures treated at a tertiary trauma center. All clavicle fractures treated at our institution over a 5-year period were reviewed by use of all available radiographic studies and medical records. These data were evaluated with respect to several epidemiologic points, including mechanism of injury, associated injuries, fracture orientation, fracture displacement, treatment, and associated injuries. Follow-up data were gathered in 32 of 44 available patients with chart review and telephone survey. We evaluated 57 medial fractures in 55 patients. Patients were typically men in the fifth decade injured as a result of vehicular trauma. Fractures were occasionally missed on chest radiographs but were always identifiable by computed tomography scan. Injuries were most often closed and without neurovascular injury. However, patients almost always had multisystem trauma. Operative treatment was rarely performed, and patients typically had little or no pain at the time of follow-up. Finally, it was found that 11 patients died within 1 month of their injuries, indicating that 20% (11/55) of patients with medial clavicle fractures died as a result of the trauma associated with their injury. Medial clavicle fractures remain a relatively uncommon injury compared with other clavicular fractures. However, they typically are accompanied by significant multisystem trauma and have a high associated mortality rate.