Chapter 83: Clavicular Fracture

Patient Story

A 15-year-old girl slipped on the ice and landed directly on her lateral shoulder. She had immediate pain and swelling in the middle of her clavicle. Her parents took her to the emergency room and a radiograph confirmed a displaced mid-clavicular fracture with considerable overlap (Figure 83-1). She was placed in a sling and saw her primary care physician the next day. In consultation with a sports medicine expert, she, her family, and her primary care physician decided on conservative treatment. A follow-up radiograph 4 months later demonstrated good healing. The bump on her clavicle is still palpable; but this does not bother her (Figure 83-2).

Introduction

Clavicular fractures are common and are most often caused by accidental trauma. The clavicle most commonly fractures in the midshaft (Figures 83-3), but can also fracture distally (Figure 83-4). Most fractures can be treated conservatively. Refer patients with significant displacement or distal fractures for surgical evaluation.

Epidemiology

Accounts for 10 to 15 percent of fractures in children; 90 percent are midshaft fractures.¹

Etiology and Pathophysiology

• Ninety percent of clavicle injuries are caused by accidental trauma from fall against the shoulder as result of a direct blow to the clavicle or can be fall on an outstretched hand.² However, stress fractures in gymnasts and divers have been reported.

• Neonatal clavicular injuries are usually from birth trauma, commonly breech presentations.

• In children under 2 years of age, a fall from the bed/crib is most common mechanism.³

• Sports injuries are common in the adolescent population.

• Physical assaults and child abuse can cause clavicular fractures and need to be considered (Figure 83-5).

• Pathologic fractures (uncommon) can result from lytic lesions, bony cancers or metastases, or ...