Clavicle fracture: Difference between revisions
| Line 4: | Line 4: | ||
*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: | ||
**Middle third | **Type I: Middle third (80% of fractures) | ||
**Distal third | **Type II: Distal third (15% of fractures) | ||
**Medial third | **Type III: Medial third (5% of fractures) | ||
*Distal fracture may be associated with coracoclavicular ligament rupture | *Distal fracture may be associated with coracoclavicular ligament rupture | ||
*Medial fracture may be associated with intrathoracic injuries | *Medial fracture may be associated with intrathoracic injuries | ||
Revision as of 17:00, 13 June 2020
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: Distal 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
- Swelling, deformity, and tenderness overlying the clavicle
- Affected arm may be supported by the contralateral arm
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
- 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