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The second fracture of the same clavicle: prevalence and fracture configurations.

OBJECTIVE
To study second fracture at the same clavicle including prevalence, fracture configurations related to malunion types of the first fracture, and healing.


MATERIAL AND METHOD
Between 2008 and 2011, the authors reviewed medical records and radiographs of the clavicles of patients who sustained acute clavicular fractures from motorcycle accident. Second fracture at the same clavicle and prevalence were studied. Malunion of the first fracture of the same clavicle were typed and configurations of the second fracture at the same clavicles were described related to type of the malunion.


RESULTS
There were 552 clavicular fractures. Four cases of which sustained a second fracture at the same clavicles. Malunion of the first clavicular fracture of the four cases were typed: type I, extension, type II, flexion, and type III, bayonet. There were one, two, and one case of second clavicular fractures of the type I, II, and III clavicular malunion. The configuration of second clavicular fracture of the type I malunion clavicle is located at lateral fragment, inferior displacement, and dorsal angulation with dorsal cortex conminution. The type II malunion clavicle is located at lateral fragment with minimal displacement. For the type III malunion clavicle, the second fracture is located at medial fragment with mild inferior displacement and inferior angulation. The four cases of the second fractures of the same clavicles healed within two months without complication.


CONCLUSION
The prevalence of second fracture at the same clacicles was 7.2:1000. The three types of the first fracture malunion were extension, flexion, and bayonet. The configuration of the second fracture at the same clavicles depends on malunion types of the first clavicular fracture. They healed without complication.