Clavicle Fractures Clinical Presentation

Updated: Jun 12, 2017
  • Author: Benjamin P Kleinhenz, MD; Chief Editor: Craig C Young, MD  more...
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Presentation

History

The patient may hear a snapping or cracking sensation at the time of the injury, Pain, swelling, and possible deformity over the clavicle may be observed.

Clavicle fractures may be caused by direct or indirect trauma. The most common mechanism is an indirect one in which the athlete falls onto the lateral shoulder, causing a compressive force across the clavicle. Examples of a direct mechanism would be a blow from a hockey stick or a direct fall onto the clavicle. At-risk athletes include those in football, hockey, and soccer and those at risk for falling during roller skating, skiing, bicycling, or horseback riding. A very high prevalence is also noted in MVAs. A less common mechanism is a fall onto an outstretched hand (ie, a FOOSH injury). The radiographs below depict clavicle fracture in a hockey player.

Comminuted fracture in a hockey player. Note the m Comminuted fracture in a hockey player. Note the medial fragment tenting the skin.
Additional view of fracture displacement and commi Additional view of fracture displacement and comminution in a hockey player. The sternocleidomastoid is the deforming force of the medial fragment.
Radiographs after open reduction and internal fixa Radiographs after open reduction and internal fixation of a comminuted fracture in a hockey player.
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Physical Examination

The patient may cradle the injured extremity with the uninjured arm.

The shoulder may appear shortened relative to the opposite side and may droop. Swelling, ecchymosis, and tenderness may be noted over the clavicle. Abrasion over the clavicle suggests the fracture was from a direct mechanism. Crepitus from the fracture ends rubbing against each other may be noted with gentle manipulation.

A thorough upper extremity examination is necessary, and special attention should be paid to the neurovascular status. Identification of an associated distal nerve dysfunction indicates a brachial plexus injury, and decreased pulses may indicate a subclavian artery injury. Venous stasis, discoloration, and swelling indicate a subclavian venous injury. [2, 3]

Difficulty breathing or diminished breath sounds on the affected side may indicate a pulmonary injury, such as a pneumothorax. Palpation of the scapula and ribs may reveal a concomitant injury. Tenting and blanching of the skin at the fracture site may indicate an impending open fracture, which most often requires surgical stabilization.

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