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Updated: Nov 26 2017

Clavicle Fracture

Snapshot
  • A 26-year-old woman presents to the emergency room after a biking accident. She reports acute pain after falling on her shoulder. On physical exam, there is swelling, erythema, and tenderness on the anterior aspect of her right shoulder. No tenting of the skin is noted. Distal pulses are intact, and there is no motor or sensory deficits. She is sent for further imaging.
Introduction
  • Clinical definition
    • fracture of the clavicle
      • classified based on location (medial third, middle third, and lateral third)
        • middle third fracture is most common
  • Epidemiology
    • demographics
      • 4-10% of adult fractures
      • more common in children and the elderly (> 70 years of age)
  • Pathogenesis
    • most commonly from direct fall on the shoulder (adults and children)
    • direct blow to the lateral aspect of the shoulder
    • birth trauma (newborns)
  • Associated conditions
    • brachial nerve palsies
  • Prognosis
    • most fractures heal well
Presentation
  • Symptoms
    • shoulder pain that worsens with any movement
  • Physical exam
    • swelling, erythema, and deformity of clavicle
    • tenderness to palpation
      • worse with passive and active movement
    • tenting of skin overlying fracture
      • indicates skin necrosis and open fracture
    • rule out associated injuries to neurovasculature
      • thorough distal pulse and neurologic exam
Imaging
  • Radiographs
    • indication
      • for all patients
    • recommend views
      • anteroposterior and clavicle view
    • findings
      • clavicular fracture
Studies
  • Making the diagnosis
    • based on clinical presentation and imaging
Differential
  • Sternal fracture
    • distinguishing factor
      • no clavicular fracture seen on imaging
      • sternal fracture seen on imaging
  • Bruise
    • distinguishing factor
      • no fractures on imaging
Treatment
  • Management approach
    • typically treated conservatively with a sling or brace
  • Conservative
    • immobilization
      • indication
        • for most patients
      • modalities
        • simple arm sling or figure-of-eight sling
  • Medical
    • nonsteroidal anti-inflammatory drugs
      • indication
        • pain management
  • Operative
    • surgical treatment
      • indication
        • fractures at risk for malunion
        • open fracture
        • skin tenting on exam
        • unstable fractures
      • surgery
        • open reduction internal fixation
Complications
  • Cosmetic deformity of shoulder
  • Limited mobility of shoulder
Question
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