Clavicle fracture typically presents in young age groups (<30 years), particularly active males, with moderate to severe pain at the fracture site following a direct fall on the shoulder (e.g., while playing sports), a road traffic accident, or other high-energy injury. The pain is worsened by shoulder range of motion or trying to use the injured extremity.
Older age (≥65 years) is a risk factor for low-energy mechanism clavicle fractures (e.g., a fall onto an outstretched hand from ground level). In this group, clavicle fractures are more common in women than in men.
Once a trauma survey has been completed, perform a focused exam of the clavicle and shoulder girdle. Assess any soft tissue swelling and ecchymosis in the area of the clavicle. Determine point tenderness on palpation; gross deformity may be present if the fracture is displaced and/or angulated.
Order clavicle x-rays for all patients with suspected clavicle fracture. You may also need to include chest and scapula x-rays.
Immediately consult an orthopedic surgery specialist for open fractures, which should be treated with urgent surgical intervention.
For closed injuries, decisions on surgical versus conservative management will be based on clinical factors, such as the fracture location and any displacement or shortening, combined with patient factors and preference.
A clavicle fracture is an abnormal disruption in the continuity of the clavicle bone and is often referred to as a broken collarbone.
History and exam
Key diagnostic factors
- presence of risk factors
- pain over clavicle
- point tenderness over site of fracture
- soft tissue swelling at site of fracture
- deformity or step-off at site of fracture
Other diagnostic factors
- ecchymosis at site of fracture
- wound overlying site of fracture
- skin tenting
- acute trauma to the clavicle
- male sex
- age <30 years
- age ≥65 years in females
- osteoporosis (pathologic fractures)
- bone tumor (pathologic fractures)
- low BMI (insufficiency fractures)
- prior fracture (insufficiency fractures)
- prolonged corticosteroid use (insufficiency fractures)
1st investigations to order
- clavicle x-ray series
- CT chest, abdomen, pelvis
Investigations to consider
- chest x-ray
- scapula x-ray series
- shoulder x-ray series
- CT clavicle
- ultrasound of clavicle
- MRI of acromioclavicular or sternoclavicular joint
involved in high-energy trauma
- Clavicle contusion
- Sprain of acromioclavicular joint
- Clinical practice guideline for the treatment of clavicle fractures
- ACR Appropriateness Criteria: shoulder pain-traumatic
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