Optimizing the radiographic technique in clavicular fractures

The purpose of this study was to assess the accuracy and utility of the posteroanterior (PA) 15° caudad view of the clavicle to assess shortening of clavicular fractures. The first stage involved taking radiographs of an adult skeleton, centered on the clavicle, with the standard anterosuperior 15° cephalad view and the PA 15° caudad view. Additional images were taken in the 15° caudad view with a series of oblique rotational views and oblique images in the vertical plane. Metal markers were placed on the clavicle at 10-mm intervals. Clavicular length and the interval between markers were measured on the radiographs. The second stage involved obtaining the PA 15° caudad radiograph in 50 patients with clavicular fractures. The noninjured clavicle also underwent radiography. The lengths of the noninjured clavicle and of the fragments of the fractured clavicle were recorded. The length of the skeletal clavicle in the standard anterosuperior image was 149 mm, with up to 19 mm of variation on oblique views. The length in the PA 15° caudad image was 130 mm, with a maximum of 4 mm of variation on the oblique views up to 30°. The true length of the skeletal clavicle was 124 mm. Forty-five fractures were diaphyseal, and five were outer-third fractures. There was less than 5 mm of measured difference in the length of injured and noninjured clavicles in 38 of 45 patients with diaphyseal fractures (84%). We have identified a more accurate technique for the assessment of fractures of the clavicle in evaluating length and clavicular alignment. The PA 15° caudad clavicle radiograph technique is well tolerated by patients. (J Shoulder Elbow Surg 2003;12:170-2)