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PATIENT STORY

A 17-year-old girl presents after falling and landing directly on her lateral shoulder. She had immediate pain and swelling in the middle of her clavicle. Her examination revealed a painful bump in the middle of her clavicle. A radiograph confirmed a midshaft clavicle fracture (Figure 104-1). She was treated conservatively with a sling. The bump on her clavicle is still palpable at 6 weeks, but X-ray reveals a healing callus (Figure 104-2).

FIGURE 104-1

Midshaft clavicle fracture. Clavicle fractures are designated midshaft (in the middle third), distal (distal third), or medial (medial third). (Reproduced with permission from E.J. Mayeaux, Jr., MD.)

FIGURE 104-2

This is the same patient as in Figure 104-1 after 6 weeks of conservative therapy. Note the bone callus forming over the break as she heals. (Reproduced with permission from E.J. Mayeaux, Jr., MD.)

INTRODUCTION

Clavicular fractures are common in both children and adults and are most commonly caused by accidental trauma. The clavicle most commonly fractures in the midshaft (Figures 104-1, 104-2, 104-3), but can also fracture distally (Figure 104-4). Many fractures can be treated conservatively. Patients with significant displacement should be referred for surgical evaluation.

FIGURE 104-3

Midshaft clavicular fracture with proximal fragment displaced superiorly from the pull of the sternocleidomastoid muscle. (Reproduced with permission from E.J. Mayeaux, Jr., MD.)

FIGURE 104-4

Distal clavicular fracture. (Reproduced with permission from E.J. Mayeaux, Jr., MD.)

EPIDEMIOLOGY

  • Clavicular fractures account for 2.6% to 4% of all fractures in adults, with an overall incidence of 64 per 100,000 people per year. Midshaft fractures account for approximately 69% to 81% of all clavicle fractures, of which half are displaced.1,2

  • Accounts for 10% to 15% of fractures in children; 90% are midshaft fractures.3

ETIOLOGY AND PATHOPHYSIOLOGY

  • Most are caused by trauma from fall against the lateral shoulder or an outstretched hand or direct blow to the clavicle; however, stress fractures in gymnasts and divers have been reported.

  • Pathologic fractures (uncommon) can result from bone tumors or radiation.

  • Birth trauma (neonatal).

  • Physical assaults and child abuse can cause clavicular fractures.

DIAGNOSIS

CLINICAL FEATURES

  • History of trauma with a mechanism known to result in clavicle fractures (i.e., fall on an outstretched hand or lateral shoulder, or direct blow).

  • Pain and swelling at the fracture site.

  • Crepitus on palpation.

  • Gross deformity ...

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