Clavicle fracture: Difference between revisions
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==Management== | ==Management== | ||
*Pain management | |||
*Place the affected extremity in a [[Sling and swathe splint|sling]] or shoulder immobilizer | *Place the affected extremity in a [[Sling and swathe splint|sling]] or shoulder immobilizer | ||
*Orthopedic surgery consultation in the ED for: | *Orthopedic surgery consultation in the ED for: | ||
Line 57: | Line 57: | ||
**Open fracture | **Open fracture | ||
**Neurovascular compromise | **Neurovascular compromise | ||
==Disposition== | ==Disposition== |
Revision as of 17:34, 13 June 2020
This page is for adult patients; see Clavicle fracture (peds) for pediatric patients
Background
- Generally secondary to shoulder trauma (direct trauma over the clavicle is less common)
- Fractured segment:
- Type I: Middle third (80% of fractures)
- Type II: Lateral third (15% of fractures)
- Type III: Medial third (5% of fractures)
- Distal fracture may be associated with coracoclavicular ligament rupture
- Medial fracture may be associated with intrathoracic injuries
Clinical Features
Presentation
- Direct trauma to lateral shoulder/clavicle or fall on outstretched arm
- Swelling, deformity, and tenderness overlying the clavicle
- Affected arm may be supported by the contralateral arm
Associated Injuries
Rare, but important to evaluate for
- Type I (middle)
- Subclavian artery/vein injury
- Nerve root and/or brachial plexus injury
- Type II (lateral)
- Coracoclavicular ligament injury
- AC joint dislocation/subluxation
- Type III (medial)
- Intrathoracic injury
- Rib fracutre
- Sternal fracture
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
Workup
- Assess distal pulse, motor, and sensation
- X-ray
- May be seen on chest x-ray, shoulder x-ray, or dedicated clavicle films (preferred)
- If high suspicion and no fracture on plain films, consider CT
Diagnosis
Allman Classification
- Type I: Middle third
- Type II: Lateral third
- Type III: Medial third
Management
- Pain management
- Place the affected extremity in a sling or shoulder immobilizer
- Orthopedic surgery consultation in the ED for:
- Displaced fracture with skin tenting
- Open fracture
- Neurovascular compromise
Disposition
- Almost all may be discharged with orthopedic surgery follow-up (if no indications for immediate surgical management; see above)
- Urgent follow-up indicated for (possible need for surgical intervention):
- Displacement
- Comminution