Emergent Care / Stabilization:

• If there is neurovascular compromise, an open fracture, or tenting of the skin, consult orthopedics immediately.
• Assess for polytrauma, particularly scapula fractures, rib fractures, pneumothorax, and hemothorax, and treat per protocol.

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