Clavicle Fracture in Emergency Medicine Follow-up
- Author: Amir Estephan, MD; Chief Editor: Rick Kulkarni, MD more...
Further Inpatient Care
The following require consideration for inpatient management:
- Open fractures
- Associated medical or traumatic conditions
- Pain control
Further Outpatient Care
- Orthopedic follow-up care
- Patient education
- Early physical therapy (eg, range of motion exercises) if indicated
Deterrence/Prevention
- Injury avoidance education
- Adequate protective gear for participation in certain sports
- Seat belt utilization
- Drug and alcohol counseling as needed
Complications
- Fractures of the middle third of the clavicle have been associated with injuries to the neurovascular bundle and the pleural dome.
- Complications after fractures of the medial third resemble complications associated with posterior sternoclavicular dislocations including pneumothorax or compression or laceration of the great vessels, trachea, or esophagus.
- Brachial plexus compression resulting from hypertrophic callus formation (may cause peripheral neuropathy)
- Delayed union or nonunion (especially with type II distal third fractures and fractures with >2 cm of shortening)
- Poor cosmetic appearance
- Posttraumatic arthritis
- Intrathoracic injury
- As with first rib fractures, great force is necessary to cause proximal third clavicle fractures; excluding underlying injuries is imperative (see the image below).
Clavicle fracture with rib fractures. Remember to look for associated injuries. - Pneumothorax
- Subclavian artery and vein injury
- Internal jugular vein injury
- Axillary artery injury
- As with first rib fractures, great force is necessary to cause proximal third clavicle fractures; excluding underlying injuries is imperative (see the image below).
Prognosis
- The prognosis of clavicle fractures is excellent in children.
- The prognosis of clavicle fractures is excellent in adults with proper follow-up care, early detection, and treatment of complications.
- Younger children generally require shorter periods of immobilization (2-4 wk) than adolescents and adults (4-8 wk).
Patient Education
- Patients should use of a sling or sling and swathe.
- Vigorous competitive play should be avoided until the bone healing is solid.
- A figure-of-eight bandage (clavicle strap) should be used.
- Educate patients about proper placement and adjustment techniques.
- Paresthesias or edema in the hands or fingers indicate that the strap is too tight and should be removed.
- The purpose of this bandage is to reduce pain by decreasing fracture fragment movement, not necessarily to maintain perfect alignment.
- This strap may be combined with a sling for added comfort.
- Neonatal clavicle fracture
- Advise parents to minimize pressure and movement of the ipsilateral arm during handling of the child.
- The parent may try to pin the infant's shirt sleeve of the affected arm to the front of the shirt to minimize movement.
- For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education articles, Broken Collarbone and Shoulder Dislocation.
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