CLAVICLE FRACTURE

Question 1

Classification

Answer 1

Proximal
Mid
Distal

Question 2

Mechanism

Answer 2

Direct impact to shoulder girdle (85%)
Direct impact to clavicle

Question 3

Symptoms

Answer 3

Acute onset anterior shoulder pain
OR
Directly over clavicle
Arm slumped inward and downward

Question 4

Physical Exam

Answer 4

Tender, swelling, crepitus and deformity over clavicle
Assess brachial plexus and subclavian vessels

Question 5

DDx

Answer 5

Distal 3rd Clavicle Fracture
Sternoclavicular Dislocation
Acromioclavicular Joint Injury

Question 6

X-RAY

Answer 6

Upright AP Clavicle view
Cephalic Tilt clavicle views
Superior displacement of the medial fragment
Inferior displacement of the lateral fragment
Shortening
Displacement

Question 7

Complications

Answer 7

Pneumothorax
Injury to subclavian and brachial plexus

Question 8

Management: non operative

Answer 8

Sling or Figure of 8 strap
Refer to Ortho
Gentle passive ROM at 2 weeks
Strengthening exercises at 6 weeks
Return to sports at 4-6 months

Question 9

Indications for Emergent Ortho Referral

Answer 9

Open fracture
Skin tenting
Subclavian artery or vein injury

Question 10

Indications for surgery: Mid clavicle

Answer 10

displaced with > 2 cm shortening

Question 11

Indications for surgery: Distal

Answer 11

Type IIA, IIB, V