Synopsis
Differentiate clavicle fracture from acromioclavicular disruption, identify threatened skin, chest and neurovascular complications, and select safe sling, follow-up or urgent orthopaedic care.
- Assess mechanism and perform ABCDE after high energy because clavicle fracture can coexist with chest, scapular, head and cervical injury.
- Inspect the whole clavicle and AC joint for wounds, abrasion, blanching and tenting without repeatedly pressing a sharp fragment.
- Record radial pulse, refill and axillary, radial, median and ulnar motor and sensory function before and after sling or manipulation.
- Obtain an AP clavicle view with an additional angled view when needed and image the chest or shoulder girdle when associated injury is suspected.
- A sling, analgesia and early guided movement suit most closed uncomplicated midshaft fractures and Rockwood I or II AC injuries.
- Open injury, threatened skin, vascular compromise, progressive neurology or unstable high-energy girdle injury needs urgent specialist treatment.
- Rockwood III AC injury is individualised by occupation, sport, symptoms and instability; types IV to VI generally need early specialist review.
- After low-trauma fracture, integrate falls and bone-health action through current outpatient and fracture-liaison services.
Key red flags
Non-blanching skin, progressive tenting, an open wound or sharp fragment beneath compromised skin requires urgent assessment.
Breathlessness, hypoxia, reduced breath sounds or surgical emphysema suggests associated pleural or rib injury.
A cool hand, pulse asymmetry, expanding supraclavicular swelling or new weakness and paraesthesia suggests vascular or plexus injury.
Pale non-blanching pressure, progressive tenting or an open wound signals impending or established tissue failure.
Hypoxia, chest pain, reduced breath sounds or surgical emphysema requires immediate pleural assessment.
Pulse change, coolness, haematoma, paraesthesia or weakness suggests subclavian-vessel or brachial-plexus damage.
Investigation priorities
Define location, displacement, shortening and comminution across the whole clavicle.
Management branches
A patient presents after impact to the shoulder girdle.
- Perform ABCDE and examine chest, neck and scapula according to mechanism.
- Document wounds, blanching, pulses, refill and named peripheral-nerve functions.
- Provide analgesia and support, image appropriately and escalate tissue or vascular threat immediately.
Examination and imaging show a closed uncomplicated fracture or low-grade AC injury.
- Use a broad-arm sling for comfort and encourage hand, wrist and elbow movement.
- Begin pendular and assisted shoulder movement as pain and local guidance permit.
- Provide warning signs and defined follow-up for persistent pain, instability or neurological change.