Clavicle fractures are common and are classified by location into proximal, middle, and distal thirds. Most clavicle fractures occur in the middle third. Point tenderness and contusion typically overlie the fracture site. Deformity is often seen. Proximal fractures are least common and require significant force, and therefore, they may have underlying life-threatening mediastinal injuries. Displaced distal clavicle fractures suggest injury to the coracoclavicular and acromioclavicular (AC) ligaments.
Clavicle Fracture. This 12-year-old boy complains of pain, tenderness, and deformity over the mid left clavicle after an injury incurred during football drills. A “kick-stand” injury is seen on plain films (see Fig. 7.15). Fracture, though overriding, healed without reduction. (Photo contributor: Lawrence B. Stack, MD.)
Management and Disposition
Most clavicle fractures are identified on an anteroposterior (AP) view of the shoulder. A 45-degree AP cephalad view may be helpful if AP films are normal and suspicion is high for fracture. A contrast-enhanced chest CT should be performed if a proximal fracture is identified, looking for mediastinal injuries. Nonoperative management using a simple sling, analgesics, and ice is adequate for most injuries. Orthopedic consultation is indicated for any medial fracture, tenting of the skin, fractures with 100% displacement, severely comminuted fractures, and displaced distal third fractures.
Tenting requires closed reduction or surgical repair.
Stress radiographs (weighted views) help differentiate minimally or nondisplaced distal third fractures from an AC joint separation.
Glenoid neck fracture plus a clavicle fracture represents a “floating” shoulder and requires urgent orthopedic consultation.
Sixty percent of childhood clavicular fractures are nondisplaced.
Clavicle Fracture Radiograph. Left midclavicle fracture with 100% displacement and overriding fragments. A “kick-stand” injury is seen. Fracture, though overriding, healed without complication. (Photo contributor: Lawrence B. Stack, MD.)
Clavicle Fracture with Skin Tenting. A 30-year-old unrestrained woman in a motor vehicle crash (MVC) complains of left clavicle pain. Skin tenting is seen. Closed reduction was required to avoid skin ischemia. (Photo contributor: R. Jason Thurman, MD.)