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A 17-year-old boy presents after falling off his skateboard and landing directly on his lateral shoulder. He had immediate pain and swelling in the middle of his clavicle. His examination revealed a bump in the middle of his clavicle. A radiograph confirmed a midclavicular fracture (Figure 102-1). He was treated conservatively with a sling, which he wore for approximately 1 of the recommended 3 weeks. A follow-up radiograph demonstrated good healing. The bump on his clavicle is still palpable; however, this does not bother him.
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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 102-1, 102-2, 102-3), but can also fracture distally (Figure 102-4). Many fractures can be treated conservatively. Refer patients with significant displacement or distal fractures for surgical evaluation.
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- Clavicular fractures account for 2.6% 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.1
- Accounts for 10% to 15% of fractures in children; 90% are midshaft fractures.2
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- Most are caused by accidental 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 lytic lesions, bony cancers or metastases, or radiation.
- Birth trauma (neonatal).
- Physical assaults, intimate partner violence, and child abuse can cause clavicular fractures.
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- 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.
- Gross deformity ...