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 examination 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.
- For general symptoms, see “.”
- Sagging of the shoulder due to downward distracting force of the weight of the upper limb on the lateral fracture fragment
- Tenting of the skin over the clavicle due to the upward distracting force of the sternocleidomastoid on the medial fracture fragment
- Shortening of the clavicle due to the medial distracting force (adduction) of the pectoralis major on the lateral fracture fragment
- 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 (see “Diagnostics” in “”)
- CT/MRI when associated injuries are suspected or x‑ray findings are inconclusive
- Other: Additional tests may be necessary
Midshaft (group I) fractures
- Mostly conservative treatment (e.g., simple shoulder sling) for 4–6 weeks
- Exception: excessively shortened or displaced fractures (require surgery)
- Stable fractures: conservative treatment (e.g., simple shoulder sling)
- Unstable fractures
- Conservative treatment (similar to group I fractures)
- Displacement is uncommon due to strong ligamentous attachments.
- See “Treatment” in “ .”
- Malalignment with cosmetic abnormalities
We list the most important complications. The selection is not exhaustive.