Clavicle Fracture

Question 1

What is the most common bony injury in children, adolescents and newborns?

Answer 1

A clavicle fracture

Question 2

What is the MOI of a clavicle fracture?

Answer 2

Mid-high energy impact to area
*middle third is most common
*will be a history of falling on shoulder or being struck over clavicle by heavy object

Question 3

What are the symptoms of a clavicular fracture?

Answer 3

1. Difficulty raising arm secondary to pain

Question 4

What will be on the physical exam?

Answer 4

1. Deformity at fracture site (tenting)
2. Tenderness
3. Assess neurovascular status
4. Assess sternoclavicular joint tenderness/dislocation
5. Assess for AC joint tenderness/injury

Question 5

What tests should be conducted?

Answer 5

1. AP X-rays of the entire clavicle (not just shoulder films)
2. CT if X-ray is unclear

Question 6

What are some complications of a clavicle fracture?

Answer 6

1. Pneumothorax (due to downward displacement of the clavicle)
2. Coracoclavicular ligament disruption
3. Hemothorax
4. Brachial plexus injuries

Question 7

What is the treatment?

Answer 7

1. Sling for 4-6 weeks
   *gentle motion begins at 3 weeks
   *no contact sports/weight lifting for 3-4 months

Question 8

What is surgical treatment used for?

Answer 8

1. Open fracture
2. Neurovascular injury
3. Severe ipsilateral chest injury

Question 9

When to refer?

Answer 9

1. If fracture is proximal 1/3
2. Painful nonunion after 4 months of treatment