Clinical signs and symptoms of clavicle fracture include the following:
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The patient may cradle the injured extremity with the uninjured arm
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The shoulder may appear shortened relative to the opposite side and may droop
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Swelling, ecchymosis, and tenderness may be noted over the clavicle
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Abrasion over the clavicle may be noted, suggesting that the fracture was from a direct mechanism
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Crepitus from the fracture ends rubbing against each other may be noted with gentle manipulation
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Difficulty breathing or diminished breath sounds on the affected side may indicate a pulmonary injury, such as a pneumothorax
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Palpation of the scapula and ribs may reveal a concomitant injury
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Tenting and blanching of the skin at the fracture site may indicate an impending open fracture, which most often requires surgical stabilization (see the image below)
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Nonuse of the arm on the affected side is a neonatal presentation
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Associated distal nerve dysfunction indicates a brachial plexus injury
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Decreased pulses may indicate a subclavian artery injury
See Clinical Presentation for more detail.
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A posterior view demonstrating a closed clavicle fracture tenting the skin (arrow), which can potentially lead to an open fracture.
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Comparison of both clavicles, with the left tenting the skin (wide arrow).
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Close-up view of clavicle tenting the skin (arrow).
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Comminuted fracture in a hockey player. Note the medial fragment tenting the skin.
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Additional view of fracture displacement and comminution in a hockey player. The sternocleidomastoid is the deforming force of the medial fragment.
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Radiographs after open reduction and internal fixation of a comminuted fracture in a hockey player.
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Anteroposterior view of middle third clavicle fracture illustrating a relatively typical fracture pattern.
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Anteroposterior view of distal clavicle fracture, type II, showing wide displacement.
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The displacing forces on a midshaft clavicle fracture.
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The displacing forces on a distal clavicle fracture.
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Type I fracture of the distal clavicle (group II). The intact ligaments hold the fragments in place.
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A type II distal clavicle fracture. In type IIA, both conoid and trapezoid ligaments are on the distal segment, while the proximal segment, without ligamentous attachments, is displaced.
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A type IIB fracture of the distal clavicle. The conoid ligament is ruptured, while the trapezoid ligament remains attached to the distal segment. The proximal fragment is displaced.
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Anatomy of the clavicle indicating potential fracture sites.
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Nondisplaced middle clavicle fracture.
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Displaced fracture of middle clavicle.
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Displaced middle clavicle fracture.
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Clavicle fracture with rib fractures. Remember to look for associated injuries.
