Clavicle fracture: Difference between revisions
| (4 intermediate revisions by the same user not shown) | |||
| Line 2: | Line 2: | ||
==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: | ||
| Line 61: | Line 62: | ||
==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) | ||
==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== | ==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
- 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)