title: Minimally displaced clavicle fracture after high-energy injury: are they likely to displace?
abstract: BACKGROUND
  Nondisplaced or minimally displaced clavicle fractures are often considered to be benign injuries. These fractures in the trauma patient population, however, may deserve closer follow-up than their low-energy counterparts. We sought to determine the initial assessment performed on these patients and the rate of subsequent fracture displacement in patients sustaining high-energy trauma when a supine chest radiograph on initial trauma survey revealed a well-aligned clavicle fracture.
  
  
  METHODS
  We retrospectively reviewed the cases of trauma alert patients who sustained a midshaft clavicle fracture (AO/OTA type 15-B) with less than 100% displacement treated at a single level 1 trauma centre between 2005 and 2010. We compared fracture displacement on initial supine chest radiographs and follow-up radiographs. Orthopedic consultation and the type of imaging studies obtained were also recorded.
  
  
  RESULTS
  Ninety-five patients with clavicle fractures met the inclusion criteria. On follow-up, 57 (60.0%) had displacement of 100% or more of the shaft width. Most patients (63.2%) in our study had an orthopedic consultation during their hospital admission, and 27.4% had clavicle radiographs taken on the day of admission.
  
  
  CONCLUSIONS
  Clavicle fractures in patients with a high-energy mechanism of injury are prone to fracture displacement, even when initial supine chest radiographs show nondisplacement. We recommend clavicle films as part of the initial evaluation for all patients with clavicle fractures and early follow-up within the first 2 weeks of injury.
authors.affiliation: The Department of Orthopaedic Surgery, University of Louisville, Louisville, KY.
authors.forename: John T
authors.initials: JT
authors.lastname: Riehl
authors.affiliation: The Orlando Regional Medical Center, Level One Orthopaedics, Orlando, FL.
authors.forename: Bill J
authors.initials: BJ
authors.lastname: Athans
authors.affiliation: The Orlando Regional Medical Center, Level One Orthopaedics, Orlando, FL.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Munro
authors.affiliation: The Orlando Regional Medical Center, Level One Orthopaedics, Orlando, FL.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Langford
authors.affiliation: The Orlando Regional Medical Center, Level One Orthopaedics, Orlando, FL.
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Kupiszewski
authors.affiliation: The Orlando Regional Medical Center, Level One Orthopaedics, Orlando, FL.
authors.forename: George J
authors.initials: GJ
authors.lastname: Haidukewych
authors.affiliation: The Orlando Regional Medical Center, Level One Orthopaedics, Orlando, FL.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Koval
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies