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Updated: Dec 27 2021

Clavicle Fracture

Images shot 2017-11-22 at 9.48.02 am.jpg
  • 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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