Clavicle fracture

Background

• Occurs via direct blow to shoulder
  • Middle third: 80%
  • Distal third: 15%
  • Medial third: 5%

Clinical Features

• Swelling, deformity, and tenderness overlying the clavicle
• Arm is supported by the other extremity
• Distal fx often assoc w/ coracoclavicular ligament rupture
• Medial fx often assoc w/ intrathoracic injuries

Imaging

• Routine imaging may miss some fractures (particularly at either end of the bone)
• CT may be required for definitive diagnosis

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Management

• Consult ortho for:
  • Open fx or persistent skin tenting
  • Comminution
  • Displacement
• Sling

See Also

• Clavicle fracture (peds)
• Fractures (Main)

Source

• Tintinalli