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.
Key red flags
Non-blanching skin, progressive tenting, an open wound or sharp fragment beneath compromised skin requires urgent assessment.
Pale non-blanching pressure, progressive tenting or an open wound signals impending or established tissue failure.
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.
Examination and imaging show a closed uncomplicated fracture or low-grade AC injury.
Key medicines
Paracetamol for adult shoulder-girdle painGive 500 mg to 1 g orally when required, leaving at least 4 hours between doses and not exceeding four doses or 4 g in 24 hours.