![]() Seven year old boy with angulated (not translated) fracture of the middle third of the clavicle. It may be needed in medial third injuries to assess tracheal impingement and thoracic anatomy, or in displaced lateral third injuries to assess the coraco-clavicular ligament, with orthopaedic consultation. ![]() What radiological investigations should be ordered?Standard anteroposterior (AP) and AP with 15 degrees cephalic tilt x-ray of the clavicle will show the fracture in two planes and define displacement.ĬT Scan is very seldom required. Vascular assessment of the arm should also be performed as the subclavian artery runs closely apposed to the clavicle in the middle third.ĥ. !Careful neurological examination should be performed to define potential (but rare) associated brachial plexus injury. Careful airway protection and neurovascular assessment is required. Toddlers may present to ED with only history of avoiding use of the arm, as the trauma may not have been witnessed.įractures of the medial third are usually the result of high impact blunt force to the anterior chest (such as in a motor vehicle accident), and can be associated with neurovascular, pulmonary and cardiac (rare) injuries. The vast majority present with pain, swelling and deformity along the line of the clavicle, and a history of a fall onto an outstretched arm. Injuries are usually the result of a fall on an outstretched hand with the force transmitted up the arm.Ī direct blow to the outer end of the clavicle (such as a fall onto the point of the shoulder during sporting activities or a striking injury) can be associated with distal third injuries and acromioclavicular joint disruption.Ĭlavicle fracture is also the most common perinatal fracture associated with birth trauma. Half of all paediatric clavicle fractures occur under the age of seven years. The clavicle is one of the most common fractured bones in children. How common are they and how do they occur? Associated sternoclavicular dislocationģ.Lateral ⅓ fractures are at higher risk of nonunion than other typesĭefined by shortening/comminution/angulation LocationĪround and lateral to coracoclavicular ligaments All fractures should be assessed using the Advanced Trauma Life Support (ATLS) principles to ensure associated and potentially significant injuries are identified.įractures of the clavicle can be classified by its anatomical location (Table 1) : Table 1: Classification of clavicle fractures by location.Medial third fractures are uncommon and require careful assessment for associated injuries, especially when displaced.Follow-up must be planned for completely off-ended fractures in older children, and for lateral third fractures. ![]() These most commonly occur in the middle third of the bone, with the vast majority healing well without intervention beyond sling immobilisation.Clavicle Fracture is a common injury in children, most often occurring after a simple fall onto an outstretched hand. ![]() What are the potential complications associated with this injury?.What is the usual ED management for this fracture?.Do I need to refer to orthopaedics now?.When is reduction (non operative and operative) required?.What radiological investigations should be ordered?.How common are they and how do they occur?. ![]()
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