- Clinical science
Clavicle fractures are common fractures that usually affect children and adolescents and typically occur from a direct fall onto the shoulder. Clavicle fractures are classified according to the fracture location with the use of the Allman classification. More than two-thirds of cases are due to a fracture in the middle third of the clavicle (group I of the Allman classification). Patients usually present with nonspecific symptoms such as swelling, focal tenderness, and reduced movement of the arm in some cases, more specific signs such as shortening and drooping of the shoulder can occur. Clinical presentation and physical exam help confirm the diagnosis. X-ray is routinely performed to confirm the diagnosis. Further testing may be necessary in certain cases (e.g., arteriography in the case of potential vascular injury). Treatment depends on the location of the fracture and includes conservative and/or surgical measures.
- Common (account for approx. 2.6% of all fractures)
- Most commonly occurs in children and adolescents
Epidemiological data refers to the US, unless otherwise specified.
- Direct fall onto the shoulder, e.g., while cycling (∼85% of cases)
- Direct blow (∼5% of cases)
- Indirect trauma, like falling onto an outstretched hand (∼5% of cases)
|Group||Location of fracture|
|I||Midshaft fracture/middle third (∼ 69% of cases)|
|Type||Location of fracture||Associated ligament injuries|
|IV|| || |
- For general symptoms, see .
- Tenting of skin overlying the clavicle
- Shortening of the clavicle
- Torn coracoclavicular ligaments: elevation of the acromioclavicular joint
- Examination for signs of fracture and concomitant injuries
- Assess for neurovascular compromise and compartment syndrome with the 6 P's: pain, pallor, pulselessness, paresthesia, paralysis and poikilothermia
- Best initial test: X‑ray in two projections (anteroposterior view, 45° cephalic tilt view) (see )
- CT/MRI when associated injuries are suspected or X‑ray findings are inconclusive
- Additional tests may be necessary, e.g., arteriography and complete blood count (CBC) in the case of suspected vascular injury, or ultrasonography in the case of suspected clavicle fracture in children.
Midshaft (group I) fractures
- Mostly conservative treatment (e.g., simple shoulder sling) for 4–6 weeks
- Exception: excessively shortened or displaced fractures (require surgery)
Lateral (group II) fractures
Treatment depends on the type of fracture according to Neer classification (see “Classification” above).
- Conservative treatment (e.g., simple shoulder sling)
- Surgical fixation (e.g., tension banding, clavicular plate) is typically indicated
- If needed, ligament repair (in type IIb fractures)
Medial (group III) fractures
- Conservative treatment (similar to group I fractures)
- Displacement is uncommon due to strong ligamentous attachments.
- See also “Therapy” in .
- Malalignment with cosmetic abnormalities
We list the most important complications. The selection is not exhaustive.