The clavicle is the long, narrow bone that joins the shoulder to the base of the neck and keeps both shoulders in line. Fractures occur at any age, but are more common in young children and adolescents because the bone has not yet solidified.
The usual cause is direct trauma from falling and striking the shoulder, or indirect trauma from falling with the arm outstretched landing on the palm of the hand.
It manifests with instant severe pain, difficulty and crunching when moving the arm, bruising, deformity of the clavicle and tingling in the arm on the same side.
It is diagnosed by interrogation of the episode and physical examination; diagnostic suspicion is confirmed by radiography.
Initial treatment is aimed at reducing pain, with standard analgesics and immobilisation of the arm. If the fracture ends are aligned, treatment will be solely analgesia and rest (3-6 weeks in children and about 10 weeks in adults); if the ends are far apart or fragmented into many pieces, surgery may be necessary. If the bone shows through the skin, it is considered an open fracture and antibiotics should be added to the treatment.
- Robert L Hatch, MD, MPH. James R Clugston, MD, MS. Jonathan Taffe, MD. Clavicle fractures. UpToDate. Apr 14, 2016.
- Eric Legome, MD. Jean M Hammel, MD. Initial evaluation and management of chest wall trauma in adults. UpToDate. sep 20, 2016.
- Rafael Laredo Ribero, Fernando Polo Simón, Victor Delgado Alcalá, David Caldevilla Bernardo. Fracturas, luxaciones y esguinces. Manual de protocolos y actuación en urgencias. Hospital Virgen de la Salud, Complejo Hospitalario de Toledo. Tercera edición. 2010. 1047:1054
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- Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 2007; 89:1.
