Fracture patterns in midshaft clavicle fractures

Abstract

Current classifications of midshaft clavicle fractures are based on radiography. The aim of the study was to evaluate the fracture pattern of clavicle fractures using 3-dimensional computed tomography (3D CT). A retrospective analysis was performed on CT scans of 65 acute clavicle fractures. Using quantitative 3D CT reconstruction techniques, the fracture of the clavicle was virtually reduced. Based on these reconstructions, a group-based fracture heat map and small fragment heat map, and the location of the most common fracture line were determined. Also, the direction and amount of displacement were evaluated. Three fracture patterns could be distinguished. The primary fracture line in type 1 is going from posteromedial to anterolateral and located between 50% and 68% of the clavicle's length. In type 2, a transverse fracture line is located around 55%, and in type 3, a superolateral to inferomedial line is located between 47% and 56%. Wedged fracture fragments can be seen in types 1 and 2 and are mainly situated inferiorly. The displacement is similar in all types, but the main direction of displacement is specific for the different types (posterior, anterior, inferior). We can conclude that several fracture patterns can be seen in clavicle fractures. Most fractures are located laterally at the midshaft of the clavicle. Wedged segments are mainly located inferiorly, and at the posterior part of the clavicle, no comminution is ever seen. The direction of displacement depends on the fracture pattern.