Clavicle Fracture

  • A break in the continuity of the clavicular bone, commonly resulting from direct trauma to the shoulder or fall onto an outstretched hand.

ANATOMY

  • Acts as a strut between the sternum and scapula
  • Protects underlying neurovascular structures (subclavian vessels, brachial plexus)
  • Divided into:
    • Medial third
    • Middle third
    • Lateral (distal) third

AETIOLOGY + PATHOPHYSIOLOGY

Etiology

  • Fall onto shoulder (most common)
  • Direct blow to clavicle
  • Fall onto outstretched hand
  • Birth trauma (neonates)

Pathophysiology

  • Medial fragment pulled upward by sternocleidomastoid
  • Lateral fragment displaced downward by arm weight
  • Results in visible deformity and shoulder droop

Allman Classification

  • Group I: Middle-third fractures
  • Group II: Lateral-third fractures
  • Group III: Medial-third fractures
notion image

CLINICAL PRESENTATION

Symptoms

  • Sudden shoulder pain
  • Inability to use affected arm
  • Pain aggravated by movement

Signs

  • Visible deformity or “step”
  • Tenderness and crepitus
  • Swelling and bruising
  • Arm held close to body
  • Shortened shoulder girdle
notion image

INVESTIGATIONS

  • X-ray clavicle
    • AP view
    • 15° cephalic tilt view (better visualization)
  • CT scan if:
    • Complex fracture
    • Suspected intra-articular involvement

MANAGEMENT

Conservative Treatment (Most Cases)

Indications:
  • Undisplaced or minimally displaced fractures (<2 cm)
  • Most middle-third fractures
Methods:
  • Arm sling or figure-of-eight bandage
  • Analgesics
  • Early gentle mobilization
Healing time:
  • Adults: 6–8 weeks
  • Children: 3–6 weeks

Surgical Treatment

Indications:
  • Open fractures
  • Neurovascular compromise
  • Skin tenting
  • Significantly displaced fractures
  • Shortening >2 cm
  • Certain distal clavicle fractures (Neer II)
  • Symptomatic nonunion
Methods:
  • Plate fixation
  • Intramedullary fixation