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Clavicle fracture

Last reviewed: 3 Apr 2025
Last updated: 13 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pain over clavicle
  • guarding
  • point tenderness over site of fracture
  • soft tissue swelling at site of fracture
  • deformity or step-off at site of fracture
  • crepitus
Full details

Other diagnostic factors

  • ecchymosis at site of fracture
  • wound overlying site of fracture
  • skin tenting
Full details

Risk factors

  • 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)
Full details

Diagnostic tests

1st tests to order

  • clavicle x-ray series
  • CT chest, abdomen, pelvis
Full details

Tests to consider

  • chest x-ray
  • scapula x-ray series
  • shoulder x-ray series
  • CT clavicle
  • ultrasound of clavicle
  • MRI of acromioclavicular or sternoclavicular joint
Full details

Treatment algorithm

INITIAL

involved in high-energy trauma

ACUTE

nonstress fractures

stress fractures

Contributors

Authors

Philip H Cohen, MD

Clinical Professor of Medicine

UCLA David Geffen School of Medicine

Los Angeles

CA

Disclosures

PHC has given lectures for MCE Conferences and received a stipend and travel expenses.

Thomas J Kremen, MD

Assistant Professor in Residence

Department of Orthopaedic Surgery

UCLA David Geffen School of Medicine

Los Angeles

CA

Disclosures

TJK is on the editorial board member for American Journal of Sports Medicine.

Fletcher R Preuss, MD

Resident Physician

Department of Orthopaedic Surgery

UCLA David Geffen School of Medicine

Los Angeles

CA

Disclosures

FRP declares that he has no competing interests.

Peer reviewers

James F. Mooney III​, ​MD

Professor

Department of Orthopedic Surgery

Atrium Health Wake Forest Baptist

Winston-Salem

NC

Disclosures

JFM declares that he has no competing interests.

Niel Kang, ​MBBS, MA (Cantab), FRCS (Tr & Orth)

Consultant Trauma and Orthopaedic Surgeon

Cambridge University Hospitals NHS Trust

Cambridge

UK

Disclosures

NK declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Song HS, Kim H. Current concepts in the treatment of midshaft clavicle fractures in adults. Clin Shoulder Elb. 2021 Sep;24(3):189-98.Full text  Abstract

Vannabouathong C, Chiu J, Patel R, et al. An evaluation of treatment options for medial, midshaft, and distal clavicle fractures: a systematic review and meta-analysis. JSES Int. 2020 Jun;4(2):256-71.Full text  Abstract

Monica J, Vredenburgh Z, Korsh J, et al. Acute shoulder injuries in adults. Am Fam Physician. 2016 Jul 15;94(2):119-27. Abstract

American College of Radiology. ACR appropriateness criteria: acute shoulder pain. 2024 [internet publication].Full text

American Academy of Orthopaedic Surgeons. Treatment of clavicle fractures. Evidence-based clinical practice guideline. Dec 2022 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Clavicle fracture images
  • Differentials

    • Clavicle contusion
    • Hematoma
    • Sprain of acromioclavicular joint
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: shoulder pain-traumatic
    • Clinical practice guideline for the treatment of clavicle fractures
    More Guidelines
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