Clavicle fracture

Clavicle fracture is relatively common. They primarily occur due to fall onto the shoulder. Fractures of the middle third of the clavicle accounts for most cases. Fracture fragments may cause pneumothorax or neurovascular injury. Treatment is conservative with a sling.

Etiology

Clavicle fracture occurs due to fall onto the shoulder in 90% of cases. Direct blow and fall onto outstretched hand accounts for the remaining cases.

Classification

Clavicle fractures are classified as affecting the medial, middle, or lateral third of the bone. Middle fractures are the most common (80% of cases).

Clinical features

Palpation of the clavicle shows a specific painful point which corresponds to the site of the fracture. Pain worsens with movement of the shoulder. Dislocated fractures may be grossly visible.

These fractures may be associated with pneumothorax (due to bone fragments penetrating the pleural cavity), or more severe injuries on nerves and vessels.

Diagnosis and evaluation

X-ray is usually sufficient.

Treatment

Treatment is almost always conservative, with closed reduction and immobilisation with an arm sling. Operative treatment may be indicated for distal or open fractures, in which case ORIF with titanium nail or plate is used.