Clavicle fracture

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

Right clavicle fracture.
Right clavicle fracture.

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

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

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

  • 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)

See Also

References