Answer
Murray et al reported that smoking was the greatest risk factor for nonunion among patients treated nonoperatively for diaphysial clavicle fractures. In a study, the investigators followed the healing course of 941 patients with such fractures and, using multivariate analysis, found that, along with smoking, both comminution and fracture displacement were particularly significant factors in nonunion.
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Media Gallery
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A posterior view demonstrating a closed clavicle fracture tenting the skin (arrow), which can potentially lead to an open fracture.
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Comparison of both clavicles, with the left tenting the skin (wide arrow).
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Close-up view of clavicle tenting the skin (arrow).
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Comminuted fracture in a hockey player. Note the medial fragment tenting the skin.
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Additional view of fracture displacement and comminution in a hockey player. The sternocleidomastoid is the deforming force of the medial fragment.
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Radiographs after open reduction and internal fixation of a comminuted fracture in a hockey player.
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Anteroposterior view of middle third clavicle fracture illustrating a relatively typical fracture pattern.
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Anteroposterior view of distal clavicle fracture, type II, showing wide displacement.
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The displacing forces on a midshaft clavicle fracture.
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The displacing forces on a distal clavicle fracture.
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Type I fracture of the distal clavicle (group II). The intact ligaments hold the fragments in place.
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A type II distal clavicle fracture. In type IIA, both conoid and trapezoid ligaments are on the distal segment, while the proximal segment, without ligamentous attachments, is displaced.
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A type IIB fracture of the distal clavicle. The conoid ligament is ruptured, while the trapezoid ligament remains attached to the distal segment. The proximal fragment is displaced.
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Anatomy of the clavicle indicating potential fracture sites.
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Nondisplaced middle clavicle fracture.
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Displaced fracture of middle clavicle.
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Displaced middle clavicle fracture.
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Clavicle fracture with rib fractures. Remember to look for associated injuries.
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