Clavicle Fracture

MANUAL MINORS

Clavicle fractures are common injuries, especially in young individuals and older adults, typically caused by falls onto the shoulder, an outstretched arm, or direct trauma. They represent 2-5% of all fractures and usually occur in the middle third of the clavicle, where the bone is thinner and more susceptible to compressive forces. Clavicle fractures can be non-displaced or displaced and, in severe cases, may compromise nearby structures such as blood vessels and nerves.

Diagnosis

The diagnosis is based on a clinical history of trauma, with symptoms including severe pain in the clavicle area, swelling, bruising, and visible or palpable deformity over the clavicle. The patient may have difficulty moving the affected arm and often supports it to relieve pain.

Anteroposterior and axial X-rays of the shoulder confirm the diagnosis, showing the location and degree of displacement of the fracture. In complex fractures, a computed tomography (CT) scan may be useful for treatment planning.

Differential Diagnosis

Pathology	Characteristics
Acromioclavicular dislocation	Pain at the top of the shoulder with deformity at the acromioclavicular joint
Humeral neck fracture	Pain and inability to move the arm, without visible clavicle deformity
Brachial plexus injury	Pain, weakness, and numbness in the arm, without bone fracture
Shoulder contusion	Local pain after trauma, with no fracture on X-ray
Scapular fracture	Pain in the back of the shoulder, associated with major trauma, visible on X-rays

Emergency Management

Initial management includes immobilising the affected arm with a sling or a figure-of-eight bandage to relieve pain and stabilise the fracture. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered for pain control.

In displaced, open fractures or those with neurovascular compromise (numbness, loss of pulse), urgent surgical evaluation is required. Uncomplicated fractures can be managed conservatively with orthopaedic follow-up.

Definitive Treatment

Definitive treatment depends on the type and severity of the fracture. Non-displaced fractures are typically managed conservatively with immobilisation for 4 to 6 weeks, followed by physiotherapy to restore mobility and strength.

Displaced or comminuted fractures, especially in young patients or athletes, may require open reduction and internal fixation (ORIF) with plates and screws to ensure proper alignment. In all cases, rehabilitation is essential to ensure full functional recovery of the shoulder and to prevent complications such as non-union or malunion.