Updated: 12/27/2021

Clavicle Fracture

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  • 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
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(M2.OR.17.4690) A 17-year-old boy comes to the emergency department following an injury during football practice. He fell and landed on the lateral aspect of his right shoulder. He is holding his right arm supported by his left arm, with his right arm adducted against his side. He is tender to palpation directly over the middle third of his clavicle. Radiographs reveal a non-displaced fracture of the middle third of the clavicle. Which of the following is the most appropriate treatment at this time?

QID: 107582

Open reduction and internal fixation with a compression plate

10%

(1/10)

Open reduction and internal fixation with an intramedullary nail

10%

(1/10)

Open reduction and internal fixation with lag screws

0%

(0/10)

Figure-of-eight splinting

70%

(7/10)

Mobilization

0%

(0/10)

M 7 B

Select Answer to see Preferred Response

(M2.OR.15.83) A 54-year-old male comes into the emergency department after a fall from a ladder. He states that his foot slipped while climbing up the ladder to clean his gutters. He fell onto his outstretched right arm and sustained the injury shown in Figure A. The patient did not sustain any other injuries from his fall and there are no abrasions or skin lacerations noted. There is no skin tenting noted over the injury site. What neurovascular structures are most at risk with this injury and should be evaluated?

QID: 106156
FIGURES:

Supraclavicular nerve and radial artery

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(0/21)

Median nerve and brachial artery

5%

(1/21)

Supraclavicular nerve and subclavian artery

48%

(10/21)

Brachial plexus and subclavian artery

43%

(9/21)

Radial nerve and subclavian artery

0%

(0/21)

M 6 E

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