Clavicle fracture: Difference between revisions
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''This page is for adult patients; see [[Clavicle fracture (peds)]] for pediatric patients'' | |||
==Background== | ==Background== | ||
* | [[File:Gray201.png|thumb|Calvicular anatomy (left anterior view).]] | ||
**Middle third | *Generally secondary to shoulder trauma (direct trauma over the clavicle is less common) | ||
** | *Fractured segment: | ||
**Medial third | **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 | ||
* | *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 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 | |||
== | ===Diagnosis=== | ||
* | ====Allman Classification==== | ||
* | *Type I: Middle third | ||
*Type II: Lateral third | |||
*Type III: Medial third | |||
==Management== | ==Management== | ||
* | *Pain management | ||
** | *Place the affected extremity in a [[Sling and swathe splint|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== | |||
*[[Clavicle fracture (peds)]] | |||
*[[Fractures (main)]] | |||
== | ==References== | ||
<references/> | |||
[[Category: | [[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
- 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
- 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)