Fractures - Clavicle

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Read the full CAHS clinical disclaimer.

See Fractures – Overview for General Assessment and Management

Mechanism of injury

Fall onto outstretched hand or direct impact to the shoulder (from fall or sporting collision)
In neonates, it may be the result of birth injury – the clavicle is the most common obstetric fracture site.
Infants may present with reluctance to use an arm without a good history of trauma.

Examination

There is usually tenderness or swelling along the clavicle.
Assess skin integrity looking for blanching or tenting (ensure the skin moves freely over the injury site).
After high force trauma, medial clavicle fractures and upper rib fractures may be associated with injury of the great vessels or brachial plexus. Careful neurovascular examination of the ipsilateral arm should be performed.
Acromioclavicular joint disruption will have tenderness and swelling over the AC joint.

Imaging

Request “clavicle XR”, rather than “shoulder XR” – AP (anterior posterior) and 15-degree cephalic tilt will be done to show displacement.
A CT (Computerised Tomography) scan may be required for medial sternoclavicular dislocation.

General management – see Fractures – Overview

Specific management

Middle third fractures

Exclude tenting of the skin.

Minimally displaced middle third fractures

Broad arm sling for 3 weeks with analgesia advice, no contact sports for 6 weeks, and a Care Following Fractured Clavicle information sheet provided.

$Minimally displaced middle third clavicle fracture$

Minimally displaced middle third clavicle fracture

Significantly displaced middle third fractures

Broad arm sling with referral to the Orthopaedic Fracture Clinic in 1-2 weeks’ time due to risk of non-union.

$Displaced middle third clavicle fracture$

Displaced middle third clavicle fracture

Medial and Lateral Third Fractures

Discuss with Orthopaedics.

$Lateral third clavicle fracture$

Lateral third clavicle fracture

Acromioclavicular Joint Disruption

Immobilise in a broad arm sling and refer to the Orthopaedic Fracture Clinic in 1-2 weeks’ time.

Neonatal Clavicle Fractures

Apply a simple swathe for 2 weeks.

References

Rang M, Pring ME, Wenger DR. Kluwer W, Rang's Children's Fractures Fourth edition. Wolters Kluwer 2018
McRae R, Max Esser M, Practical Fracture Treatment Fifth Edition, Churchill Livingstone, 2008

Endorsed by:	Co-director Surgical Services (Nursing)	Date:	Mar 2024
		Review date:	Feb 2027

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