Snapshot A 26-year-old woman presents to the emergency room after a biking accident. She reports acute pain after falling on her shoulder. On physical exam, there is swelling, erythema, and tenderness on the anterior aspect of her right shoulder. No tenting of the skin is noted. Distal pulses are intact, and there is no motor or sensory deficits. She is sent for further imaging. Introduction Clinical definition fracture of the clavicle classified based on location (medial third, middle third, and lateral third) middle third fracture is most common Epidemiology Demographics 4-10% of adult fractures more common in children and the elderly (> 70 years of age) Etiology Pathogenesis most commonly from direct fall on the shoulder (adults and children) direct blow to the lateral aspect of the shoulder birth trauma (newborns) Associated conditions brachial nerve palsies Presentation Symptoms shoulder pain that worsens with any movement of arm Physical exam swelling, erythema, and deformity of clavicle tenderness to palpation worse with passive and active movement tenting of skin overlying fracture indicates skin necrosis and open fracture rule out associated injuries to neurovasculature thorough distal pulse and neurologic exam Imaging Radiographs indication for all patients recommend views anteroposterior and clavicle view findings clavicular fracture Studies Diagnosis based on clinical presentation and imaging Differential Sternal fracture distinguishing factor no clavicular fracture seen on imaging sternal fracture seen on imaging Bruise distinguishing factor no fractures on imaging Treatment Nonoperative immobilization in sling indication standard of care for for most patients modalities simple arm sling or figure-of-eight sling nonsteroidal anti-inflammatory drugs for pain management Operative surgical open reduction and internal fixation indication fractures at risk for malunion open fracture skin tenting on exam unstable fractures neurovascular compromise surgery open reduction internal fixation Complications Cosmetic deformity of shoulder Limited mobility of shoulder Prognosis Most fractures heal well