Fracture of clavicle

Fracture of clavicle

Clavicular fractures are common injuries that account for approximately 5% of all fractures seen in the Emergency Services. In neonates and children, these fractures are very common and generally heal well. In adults, the force required to fracture the clavicle is greater, healing occurs at a slower rate, and risk of potential complications is higher.

While the overwhelming majority of clavicle fractures are benign, associated life-threatening intrathoracic injuries are possible. Complications vary based on location of fracture.

Age

Clavicle fractures are the most common of all pediatric fractures. They can present in the newborn period, especially following a difficult delivery, and nearly half of all clavicle fractures occur in children younger than 7 years. In young children, the fracture is often incomplete (i.e. greenstick fracture) or a bowing deformity without definite fracture.

Mechanism of injury

  • The patient typically reports a fall onto an outstretched upper extremity, a fall onto a shoulder, or direct Clavicular trauma.
  • Pain, especially with upper extremity movement
  • Swelling

Physical

  • Tenderness
  • Crepitus
  • Edema
  • Deformity
  • Ecchymosis- especially when severe displacement causes tenting of skin
  • Bleeding from open fracture (rare)
  • Decreased breath sounds on auscultation, indicating possible pneumothorax
  • Decreased pulses or evidence of decreased perfusion on vascular examination, suggesting vascular compromise
  • Diminished sensation or weakness on distal neurovascular examination, suggesting neurologic compromise
  • Nonuse of the arm on the affected side in neonates

Causes

  • Fall onto a shoulder or an outstretched upper extremity
  • Direct blow to the clavicle

Imaging Studies

  • Routine clavicle radiography
  • Fracture is usually demonstrated on an anteroposterior (AP) view.
  • Apical lordotic views may be required to define the degree of displacement.

Other Tests

  • Other tests may be required when clinically indicated to assess the possibility of life-threatening associated injuries.
  • Chest radiography, if pneumothorax suspected
  • Angiography, if vascular injury suspected

Prehospital Care

  • Identify and treat associated life-threatening injuries.
  • Use the ABC approach to the evaluation, and stabilize the patient.
  • Perform a careful secondary survey.
  • Apply a cold pack to the injury.
  • Immobilize the upper extremity with a sling.