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Clavicle fracture
From WikEM
This page is for adult patients; see Clavicle fracture (peds) for pediatric patients
Contents
Background
- Middle third: 80%
- Distal third: 15%
- Medial third: 5%
Clinical Features
- Occurs via direct blow to shoulder
- Swelling, deformity, and tenderness overlying the clavicle
- Arm is supported by the other extremity
- Distal fracture often associated with coracoclavicular ligament rupture
- Medial fracture often associated with intrathoracic injuries
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 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
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
- CXR
- XR should include both AC joints, to allow better comparison
- Consider dedicated clavicle or shoulder XR
- If high suspicion and fracture on CXR, consider CT
- Routine imaging may miss some fractures (particularly at either end of the bone)
Management
Consult ortho for
- Open fracture or persistent skin tenting
- Comminution
- Displacement
