Evaluation of clavicular fracture

evaluation of a clavicular fracture

Patients usually present with a history of an episode of trauma that has resulted in acute shoulder pain (1).

• it is important to determine the mechanism of injury since high energy mechanism usually seen in the young population usually have associated rib, scapular, or ipsilateral upper extremity fractures

Typically the patient has the affected arm adducted close to the body, while the opposite hand is used to support the affected side (2).

Physical examination may reveal the following:

• ecchymosis, edema, focal tenderness
• crepitation on palpation over the clavicle (2)
• skin breaks or skin tenting should be identified if present (1)

It is important to perform a neurovascular and lung examination since posteriorly displaced fractures may cause injury to the subclavian vessels, brachial plexus, and the lung apex (2)

Work up should include:

• radiography -
  • should be performed on all patients
  • standard anteroposterior view should detect most fractures
  • standard anteroposterior view with 45-degree cephalic tilt in some patients
• CT - in rare cases of distal or proximal fracture to assess the extent of intra-articular involvement (2)

Reference:

• (1) Toogood P et al. Clavicle fractures: a review of the literature and update on treatment. Phys Sportsmed. 2011;39(3):142-50.
• (2) Pecci M, Kreher JB. Clavicle fractures. Am Fam Physician. 2008;77(1):65-70.