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Clavicle fracture in Adult
Other Resources UpToDate PubMed

Clavicle fracture in Adult

Contributors: Kole E. Niemi MD, Robert Lachky MD, Eric Ingerowski MD, FAAP, Stephanie E. Siegrist MD
Other Resources UpToDate PubMed

Synopsis

Emergent Care / Stabilization:
Causes / typical injury mechanism: Clavicle fracture can occur from direct trauma to the shoulder or clavicle, or as a result of falling onto an outstretched arm. This injury should be considered in polytrauma patients, such as from a high-energy motor vehicle crash. Most fractures occur in the middle third, followed by the distal third.

Classic history and presentation: A clavicle fracture is often a sports injury. The typical patient is a high school football player presenting to the ED after an injury on the field, falling on the lateral aspect of the shoulder while being tackled. The patient may feel a "pop" before experiencing pain in the shoulder and/or collarbone. Range of motion of the shoulder may be limited by pain, and the patient may keep their arm adducted and internally rotated.

Prevalence:
  • Age – Patients are usually either active young adults (typically younger than 30 years) or older than 55 years.
  • Sex / gender – Clavicle fracture is more common in males.
Risk factors:
  • Contact sports
  • Fall onto an outstretched hand
  • Motor vehicle trauma
  • Osteopenia
  • Advanced age
Pathophysiology: Direct or transmitted forces along an outstretched arm load the shoulder and clavicle. The middle third of the clavicle is most susceptible to fracture as it is the thinnest part of the bone and is not reinforced by muscle or ligaments.

Grade / classification system:  Classified by location, fracture pattern, and integrity of stabilizing ligaments:
  • Medial (proximal) third:
    • Extra-articular
    • Articular
    • Complete articular
  • Middle third:
    • Simple
    • Wedge
    • Multifragmentary / comminuted
  • Lateral (distal) third:
    • Nondisplaced, coracoclavicular (CC) ligaments intact
    • Displaced, CC ligaments intact
    • Displaced, CC ligaments disrupted

Codes

ICD10CM:
S42.009A – Fracture of unspecified part of unspecified clavicle, initial encounter for closed fracture
S42.009B – Fracture of unspecified part of unspecified clavicle, initial encounter for open fracture

SNOMEDCT:
58150001 – Fracture of clavicle

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Polytrauma – In the case of clavicle fracture, it is always necessary to rule out more serious traumatic injuries.
  • Chest wall contusion
  • Pulmonary contusion
  • Pneumothorax
  • Brachial plexus injury
  • Sternoclavicular dislocation (see Anterior shoulder dislocation, Posterior shoulder dislocation)
  • Acromioclavicular joint separation
  • Shoulder (glenohumeral) dislocation (see Anterior shoulder dislocation, Posterior shoulder dislocation)
  • Rotator cuff tear
  • Scapula fracture
  • Proximal humerus fracture
  • Rib fracture

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:04/30/2023
Last Updated:05/15/2023
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Clavicle fracture in Adult
Copyright © 2024 VisualDx®. All rights reserved.