Clavicle Fracture
Classification systems
- Robinson / Edinburgh (location plus displacement and comminution)
Mechanism
Usually a fall onto the point of the shoulder or a direct blow, transmitting force along the clavicle; less often a fall on the outstretched hand. Sporting collisions and bicycle falls dominate in young adults, simple domestic falls in the elderly.
Age considerations
- Paediatric
- Frequently a greenstick or minimally displaced injury with vigorous remodelling potential, so a sling and symptomatic treatment suffices in almost all cases. The neonatal clavicle fracture from birth trauma needs only reassurance and gentle handling.
- Young adult
- Shortening, comminution and significant displacement in an active or overhead-working patient are the usual triggers for discussing fixation, because malunion can cause shoulder girdle fatigue and altered scapular mechanics.
- Elderly
- Non-operative treatment is well tolerated; the cosmetic bump matters less than avoiding wound and implant problems in thin skin. Screen for the fall cause and bone health.
Management options
Sling immobilisation and early rehabilitationshowhide
Indication
Most midshaft fractures with acceptable alignment, all paediatric fractures, and lateral-end injuries with intact ligaments.
Implant design notes
No implant. A simple broad-arm sling for comfort; figure-of-eight bandages offer no alignment advantage and cause skin problems.
Approach
Non-operative, with pendulum exercises early and progressive elevation as pain settles.
Steps overview
- Document neurovascular status and skin integrity, especially skin tenting
- Exclude an associated scapular, rib or first-rib injury and check breath sounds
- Apply a broad-arm sling for comfort, typically for two to three weeks
- Start pendulum and elbow, wrist and hand exercises immediately
- Progress active elevation as pain allows once fracture tenderness settles
- Review clinically and radiographically at three and six weeks
Notes
Warn the patient about a permanent visible or palpable bump and the possibility of a symptomatic non-union in comminuted shortened patterns.
Resident summary compiled from standard orthopaedic trauma teaching; verify against your departmental protocol.
Plate fixation (superior or anteroinferior)showhide
Indication
Significant shortening or displacement in an active patient, open injury, impending skin compromise, symptomatic non-union, or a floating shoulder pattern.
Implant design notes
Pre-contoured clavicle plate matching the S-shaped curvature. Superior placement resists gravity-driven bending best; anteroinferior placement keeps the implant away from thin superior skin and directs screws away from the subclavian structures.
Approach
Incision along or just inferior to the clavicle, protecting the supraclavicular nerve branches — injury to them causes a numb patch that patients notice.
Steps overview
- Beach-chair or supine position with the head turned away and image intensifier available
- Incise along the clavicle, identifying and protecting supraclavicular nerve branches
- Expose the fracture subperiosteally, preserving any large butterfly fragment's soft tissue attachment
- Restore length and rotation, holding with a clamp; lag a suitable oblique fragment
- Apply the pre-contoured plate with at least three screws each side, drilling with care for the structures beneath
- Confirm alignment and screw lengths fluoroscopically, then close in layers
Notes
Implant prominence with irritation from clothing and bag straps is the commonest reason for later removal. Drilling too deep at the medial third risks the subclavian vessels.
Resident summary compiled from standard orthopaedic trauma teaching; verify against your departmental protocol.
Viva pearls
- Skin tenting, an open injury and an associated vascular problem are the true urgent indications — everything else is a discussion about function and cosmesis.
- The figure-of-eight bandage does not hold the reduction; do not offer it as your answer.
- Supraclavicular nerve branches cross the operative field; warning the patient about numbness pre-operatively saves an unhappy post-operative conversation.
- Look for the floating shoulder: a clavicle fracture with a glenoid neck fracture destabilises the whole shoulder suspensory complex.
Sources for further reading
- Rockwood and Green's Fractures in Adults — clavicle and shoulder girdle
- Standard operative orthopaedics textbook — shoulder trauma
- Apley and Solomon's System of Orthopaedics and Trauma — shoulder girdle injuries
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Resident-authored study summary in original wording, not reproduced from copyrighted source text.