Acute injuries related to a blow to the clavicle or from falling on the shoulder.
Patients usually hold the ipsilateral arm close to te trunk to decrease pain on movement.
The head tends to move to the side of the injury to reduce forces from the sternocleidomastoid and trapezius muscles.
Examination reveals a deformity at the clavicle with tenderness at he fracture site, with inability to abduct the arm at the shoulder.
Described as proximal, distal and middle in nature.
The proximal fracture attaches to the sternum, the distal fracture attaches to the acromion, and the middle segment fracture is between the two.
X-rays with an antero-posterior view of the clavicle usually show the fracture of the middle and distal segments well.
X-rays in the 45 degree cephalic and caudal view can help clarify lesions difficult to view.
CT scans may help to identify proximal fractures and sternoclavicular dislocations.
CT scan should be done if a significant dislocation is present to establish surrounding tissue evaluation.
Commonly associated injuries include an acromioclavicular joint separation and a sternoclavicular joint dislocation.
Treatment for an adult is immobilization of the arm with a sling or figure-of-eight strap for 4-6 weeks.
after three weeks of immobilization active range of motion exercises can begin.
Children and adolescents can do well with 2 weeks of immobilization.
A bone callus may form following healing leaving a visible deformity without functional compromise.
Conservative treatment has a low complication rate.
About 2% of fractures heal improperly and they are usually comminuted and displaced.
Displaced distal fractures usually require surgical intervention as ligament disruption is present.