CLAVICLE FRACTURE

Question 1

clavicle fxs results from

Answer 1

falling on shoulder or being struck over clavicle

-Most common bony injury

Question 2

How are clavicle fxs classified

Answer 2

based on anatomic location:

(a) Middle third
(b) Distal third
(c) Proximal third

Question 3

Whats the most common location for clavicle fx

Answer 3

middle third

Question 4

Clinical Symptoms of a clavicle fracture

Answer 4

(1) Pain over fracture site

(2) Pain with arm motion

Question 5

Physical Exam of a clavicle fracture

Answer 5

(1) Inspection
(a) Bony deformity, bump, as well as shoulder droop
(2) Palpation
(a) Gentle pressure over fracture will elicit pain
(3) ROM
(a) Decreased due to pain. Grinding noted when patient attempts to move arm.
(4) Muscle Tests
(a) Decreased due to pain
(5) Neurovascular Tests
(a) Assess axillary, musculocutaneous, median, ulnar and radial nerve function
distal to the fracture
(b) Assess radial pulse and capillary refill
(6) Special Tests
(a) Positive Cross-Body test with possible grinding
(b) Not required if obvious deformity is noted

Question 6

Diagnostic Tests of a clavicle fracture

Answer 6

(1) AP and 10 degree cephalic tilt radiographic views confirm most clavicle fractures

Question 7

Treatment of a clavicle fracture

Answer 7

(1) Ice
(2) Analgesics (consider narcotic-level pain control)
(3) Orthopedic consult
(4) Mid-shaft fracture with minimal displacement and no neurovascular injury
(a) Figure-of-8 strap for 6-8 weeks

Question 8

Referral Decisions/Red Flags of a clavicle fracture

Answer 8

(1) All fractures require referral – MEDEVAC
(2) Painful nonunion after 4 months of treatment
(3) Widely displaced lateral or mid-shaft fractures or segmental fractures