Clavicle fracture: Difference between revisions

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''This page is for adult patients; see [[Clavicle fracture (peds)]] for pediatric patients''
==Background==
==Background==
*Occurs via direct blow to shoulder
[[File:Gray201.png|thumb|Calvicular anatomy (left anterior view).]]
**Middle third: 80%
*Generally secondary to shoulder trauma (direct trauma over the clavicle is less common)
**Distal third: 15%
*Fractured segment:
**Medial third: 5%
**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==
==Clinical Features==
[[File:Clavicle fracture 1.jpg|thumb|Right clavicle fracture.]]
[[File:IMG 3824.jpg|thumb|Right clavicle fracture.]]
===Presentation===
*Direct trauma to lateral shoulder/clavicle or fall on outstretched arm
*Swelling, deformity, and tenderness overlying the clavicle
*Swelling, deformity, and tenderness overlying the clavicle
*Arm is supported by the other extremity
*Affected arm may be supported by the contralateral arm
*Distal fx often assoc w/ coracoclavicular ligament rupture
 
*Medial fx often assoc w/ intrathoracic injuries
===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 DDX}}
{{Shoulder DDX}}
 
==Evaluation==
[[File:Clavicle Fracture Left.jpg|thumb|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


==Imaging==
===Diagnosis===
*Routine imaging may miss some fractures (particularly at either end of the bone)
====Allman Classification====
*CT may be required for definitive diagnosis
*Type I: Middle third
*Type II: Lateral third
*Type III: Medial third


==Management==
==Management==
*Consult ortho for:
*Pain management
**Open fx or persistent skin tenting
*Place the affected extremity in a [[Sling and swathe splint|sling]] or shoulder immobilizer
**Comminution
 
**Displacement
*Orthopedic surgery consultation in the ED for:
*Sling
**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==
*[[Clavicle fracture (peds)]]
*[[Fractures (main)]]


==Source==
==References==
*Tintinalli
<references/>


[[Category:Ortho]]
[[Category:Orthopedics]]

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