Clavicle Fracture in Emergency Medicine Workup

  • Author: Amir Estephan, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Sep 28, 2010
 

Imaging Studies

  • Routine clavicle radiography
    • Fracture is usually demonstrated on an anteroposterior (AP) view.
    • Apical lordotic views (an AP view with the tube directed 45° cephalad) may be required to define the degree of displacement.
    • Initial radiographs may appear normal despite suggestive clinical findings. In these instances, the arm should be immobilized in a simple sling, and the radiographs repeated in 7-10 days if symptoms persist.
  • CT scan may be required because routine clavicle radiographs may miss fractures due to overlap of surrounding structures, particularly at either end of the bone.
  • Cross et al found that bedside ultrasonography can accurately diagnose clavicle fractures in children. In a prospective study in 100 pediatric emergency department patients, 43 of whom proved to have clavicle fractures by radiography, ultrasonography demonstrated overall accuracy of 96%, with a positive predictive value of 95% and a negative predictive value of 96%. Ultrasonography caused no more discomfort than radiography.[3]

Also see, Clavicle, Fractures and Dislocations.

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Other Tests

  • Other tests may be required when clinically indicated to assess the possibility of life-threatening associated injuries.
    • Chest radiography, if pneumothorax suspected
    • Angiography, if vascular injury suspected
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Contributor Information and Disclosures
Author

Amir Estephan, MD  Resident Physician, Department of Emergency Medicine, Kings County Hospital Center, Brooklyn

Amir Estephan, MD, is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Coauthor(s)

Robert J Gore, MD  Clinical Assistant Professor, Attending Physician, Assistant Residency Director, Department of Emergency Medicine, Kings County/State University of New York Downstate Hospital

Robert J Gore, MD is a member of the following medical societies: American College of Emergency Physicians, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Tom Scaletta, MD  Chairperson, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

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 

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

References

  1. Simon RR, Koenigsknecht SJ. Clavicle fractures. In: Emergency Orthopedics: The Extremities. 5th ed. McGraw-Hill; 2007.

  2. Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am. Feb 2009;91(2):447-60. [Medline].

  3. Cross KP, Warkentine FH, Kim IK, Gracely E, Paul RI. Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Acad Emerg Med. Jul 2010;17(7):687-93. [Medline].

  4. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev. Apr 15 2009;CD007121. [Medline].

  5. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma. Feb 2009;23(2):106-12. [Medline].

  6. Pujalte GG, Housner JA. Management of clavicle fractures. Curr Sports Med Rep. Sep-Oct 2008;7(5):275-80. [Medline].

  7. Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elbow Surg. Mar 23 2010;[Medline].

  8. Low AK, Duckworth DG, Bokor DJ. Operative outcome of displaced medial-end clavicle fractures in adults. J Shoulder Elbow Surg. Sep-Oct 2008;17(5):751-4. [Medline].

 
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Anatomy of the clavicle indicating potential fracture sites.
Nondisplaced middle clavicle fracture.
Displaced fracture of middle clavicle.
Displaced middle clavicle fracture.
Clavicle fracture with rib fractures. Remember to look for associated injuries.
 
 
 
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