Clavicle fracture

Clinical presentation

Patient may describe acute pain over the shoulder after falling onto lateral aspect of the shoulder or after direct impact onto the clavicle. Depends on the mechanism, it is important to look for other associated injuries such as chest injuries (rib fractures, pneumothorax), head injury, and fracture to the scapular.

History

Inquire about the mechanism. Ask about hand dominance, occupation, smoking status as well as other significant past medical history and drug history.

Clinical signs / examination

Looking for swelling, bruising and localised tenderness over the clavicle. Also check neurovascular status and skin integrity.

Tenting of the skin may occur in displaced clavicle fracture. When the tenting is severe, the skin integrity may become compromised. The description of "tenting" is quite subjective but the most important evaluation is looking for impending necrosis of the overlying skin. (skin may become pale / blanching / the underlying fragment spike may be sharp and close to skin)

Examples of tenting with impending necrosis:

Investigation

XR clavicle views

A&E management

1. analgesia

2. broad arm sling

3. on-line referral to VFC

4. If skin compromised - refer to ortho on-call for review.