Clavicle fracture

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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:
    • Middle third: 80%
    • Distal third: 15%
    • Medial third: 5%
  • Distal fracture may be associated with coracoclavicular ligament rupture
  • Medial fracture may be associated with intrathoracic injuries

Clinical Features

  • Swelling, deformity, and tenderness overlying the clavicle
  • Affected arm may be supported by the contralateral arm

Differential Diagnosis

Thoracic Trauma

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

  • 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

Management

  • Place the affected extremity in a sling
  • Pain management

Disposition

  • Almost all may be discharged with orthopedic surgery follow-up
  • Urgent follow-up indicated for (possible need for surgical intervention):
    • Displacement
    • Comminution
    • >2cm of shortening
  • Orthopedic surgery consultation in the ED for:
    • Skin tenting
    • Open fracture
    • Neurovascular compromise

See Also

References