Clavicle Fracture
What is it: A clavicle fracture is a break in the collarbone. Because the bone is commonly divided into three sections, fractures are described as being in the proximal, middle or distal third of the clavicle. Each designation has implications for clinical treatment.
How does it present: Patients will often present with pain over their clavicle. The injury commonly occurs from a fall onto a shoulder or outstretched arm or if there has been direct trauma to the clavicle.
Common exam findings: You may notice swelling, ecchymosis or a prominence of the clavicle at the region of the fracture. Patients may be too uncomfortable to move their arm well.
Tests and treatment: X-rays are indicated to evaluate and classify a clavicular fracture. Fractures of the middle third of the clavicle can be treated with a sling or figure eight bracing for several weeks with increasing range of motion of the shoulder as pain permits. Distal clavicular fractures are further classified based on: (1) the location of the injury along the distal clavicle; and (2) whether supporting ligaments or AC joint have also sustained injury. Some distal clavicular fractures may require orthopedic referral for surgical intervention. In contrast, most proximal (and middle) clavicular fractures can be treated conservatively, but care should be taken to ensure no sternal fracture or sternoclavicular dislocations are present, thereby necessitating orthopedic referral. A CT scan may help in this differential.