Clavicle fracture: Difference between revisions

 
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==Background==
==Background==
[[File:Gray201.png|thumb|Calvicular anatomy (left anterior view).]]
*Generally secondary to shoulder trauma (direct trauma over the clavicle is less common)
*Generally secondary to shoulder trauma (direct trauma over the clavicle is less common)
*Fractured segment:
*Fractured segment:
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*Affected arm may be supported by the contralateral arm
*Affected arm may be supported by the contralateral arm


===Associated Injuries (Rare)===
===Associated Injuries===
''Rare, but important to evaluate for''
*Type I (middle)
*Type I (middle)
**Subclavian artery/vein injury
**Subclavian artery/vein injury
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===Diagnosis===
===Diagnosis===
*Fractured segment:
====Allman Classification====
**Type I: Middle third
*Type I: Middle third
**Type II: Lateral third
*Type II: Lateral third
**Type III: Medial third
*Type III: Medial third


==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
*Pain management


*Orthopedic surgery consultation in the ED for:
*Orthopedic surgery consultation in the ED for:
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**Open fracture
**Open fracture
**Neurovascular compromise
**Neurovascular compromise
**Floating shoulder (distal clavicle and scapula neck fracture with >10 mm displacement)
**Adolescent fractures with significant shortening (>2cm)


==Disposition==
==Disposition==
*Almost all may be discharged with orthopedic surgery follow-up (if no indications for immediate surgical management; see above)
*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
==Speciality Care==
**Comminution
*Type I (middle)
**Almost all non-operative
*Type II (lateral)
**Depends on stable vs unstable clasification pattern (e.g. Neer IIA, IIB, V)
*Type III (medial)


==See Also==
==See Also==

Latest revision as of 14:04, 10 April 2021

This page is for adult patients; see Clavicle fracture (peds) for pediatric patients

Background

Calvicular anatomy (left anterior view).
  • 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

Right clavicle fracture.
Right clavicle fracture.

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

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

Left clavicle fracture on xray.

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
    • Adolescent fractures with significant shortening (>2cm)

Disposition

  • Almost all may be discharged with orthopedic surgery follow-up (if no indications for immediate surgical management; see above)

Speciality Care

  • Type I (middle)
    • Almost all non-operative
  • Type II (lateral)
    • Depends on stable vs unstable clasification pattern (e.g. Neer IIA, IIB, V)
  • Type III (medial)

See Also

References