eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Clavicle

Author: Lawrence C Brilliant, MD, Clinical Assistant Professor, Department of Primary Care and Community Services, Hahnemann University; Attending Physician, Department of Emergency Medicine, Doylestown Hospital
Contributor Information and Disclosures

Updated: Aug 13, 2007

Introduction

Background

Clavicular fractures are common injuries that account for approximately 5% of all fractures seen in the ED. 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.

Pathophysiology

The clavicle is the sole articulation of the shoulder girdle to the trunk. It protects major underlying vessels, lung, and brachial plexus. Displaced clavicle fractures can injure these structures because of their proximity and sharp edges.

Approximately 80% of clavicle fractures occur in the middle third (class A), 15% involve the distal or lateral third (class B), and 5% involve the proximal or medial third (class C). The anatomy of the clavicle with potential fracture sites marked is shown in Media file 1.

Class B fractures are classified further as type I or nondisplaced, in which supporting ligaments remain intact with no significant displacement of fracture fragments (see Media file 2); type II or displaced, in which the coracoclavicular ligament ruptures with resultant upward displacement of the proximal segment because of sternocleidomastoid muscle (see Media files 3-4); and type III or articular surface, involving the acromioclavicular joint.

Frequency

United States

Clavicular fractures account for approximately 5% of ED visits for fractures.

Mortality/Morbidity

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

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 (ie, greenstick fracture) or a bowing deformity without definite fracture.

Clinical

History

  • 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

More on Fracture, Clavicle

Overview: Fracture, Clavicle
Differential Diagnoses & Workup: Fracture, Clavicle
Treatment & Medication: Fracture, Clavicle
Follow-up: Fracture, Clavicle
Multimedia: Fracture, Clavicle
References
[ CLOSE WINDOW ]

References

  1. Andersen K, Jensen PO, Lauritzen J. Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling. Acta Orthop Scand. Feb 1987;58(1):71-4. [Medline].

  2. Eiff MP. Management of clavicle fractures. Am Fam Physician. Jan 1997;55(1):121-8. [Medline].

  3. Post M. Current concepts in the treatment of fractures of the clavicle. Clin Orthop Relat Res. Aug 1989;(245):89-101. [Medline].

  4. Simon RR, Koenigsknecht SJ. The clavicle. In: Emergency Orthopedics-The Extremities. Appleton & Lange; 1996:199-205.

  5. Williams RJ. Significant pneumothorax complicating a fractured clavicle. J Accid Emerg Med. Sep 1995;12(3):218-9. [Medline].

  6. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. Jan 2007;89(1):1-10. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

clavicular fractures, clavicula, collar bone, collarbone, displaced clavicle fractures

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Lawrence C Brilliant, MD, Clinical Assistant Professor, Department of Primary Care and Community Services, Hahnemann University; Attending Physician, Department of Emergency Medicine, Doylestown Hospital
Lawrence C Brilliant, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Tom Scaletta, MD, Past-President, American Academy of Emergency Medicine; Chairperson, Department of Emergency Medicine, Edward Hospital; Assistant Professor of Emergency Medicine, Rush Medical College and Cook County Hospital
Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.