What is the role of CT scanning in the diagnosis of clavicle fractures?

Answer

CT scanning with 3-D reconstruction may be used to further evaluate displaced fractures. In the case of medial clavicle fractures, CT scans can show any evidence of posterior displacement of the fracture and injury to the neurovascular structures.

In addition, CT scanning may be required because routine clavicle radiographs may miss fractures due to overlap of surrounding structures, particularly at either end of the bone.

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Media Gallery

A posterior view demonstrating a closed clavicle fracture tenting the skin (arrow), which can potentially lead to an open fracture.
Comparison of both clavicles, with the left tenting the skin (wide arrow).
Close-up view of clavicle tenting the skin (arrow).
Comminuted fracture in a hockey player. Note the medial fragment tenting the skin.
Additional view of fracture displacement and comminution in a hockey player. The sternocleidomastoid is the deforming force of the medial fragment.
Radiographs after open reduction and internal fixation of a comminuted fracture in a hockey player.
Anteroposterior view of middle third clavicle fracture illustrating a relatively typical fracture pattern.
Anteroposterior view of distal clavicle fracture, type II, showing wide displacement.
The displacing forces on a midshaft clavicle fracture.
The displacing forces on a distal clavicle fracture.
Type I fracture of the distal clavicle (group II). The intact ligaments hold the fragments in place.
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.
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.
Anatomy of the clavicle indicating potential fracture sites.
Nondisplaced middle clavicle fracture.
Displaced fracture of middle clavicle.
Displaced middle clavicle fracture.
Clavicle fracture with rib fractures. Remember to look for associated injuries.

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Author

Benjamin P Kleinhenz, MD Clinical Instructor, Mary S Stern Hand Surgery Fellowship, University of Cincinnati College of Medicine; Consulting Surgeon, Hand Surgery Specialists of Cincinnati

Benjamin P Kleinhenz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Lawrence C Brilliant, MD Clinical Assistant Professor, Department of Primary Care and Community Services, MCP Hahnemann University; Attending Physician, Department of Emergency Medicine, Doylestown Hospital

Lawrence C Brilliant, MD is a member of the following medical societies: American College of Emergency Physicians