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9.03 Collarbone (clavicle) fracture


Presentation

The patient has fallen onto his shouldr or outstretched arm or more commonly has received a direct blow to the clavicle, and now presents with pain to direct palpation over the clavicle or with movement of the arm or neck. there may be deformity of the bone with swelling and ecchymosis. An infant or small child might present after a fall, not moving the arm, with a normal examination of the arm, but with the bove findings.

What to do:

What not to do:

Discussion

In children, fracture of the clavicle requires very little force and usually heals rapidly and without complication. In acults, however, this fracture usually results from a greater force and is associated with other injuries and complications. Clavicle fractures are sometimes associated with a hematoma from the subclavian vein, but other nearby structures, including the carotid artery, brachial plexus and lung, are usually protected by the underlying anterior scalene muscle and the tendency of the sternocleido-mastoid muscle to pull up the medial fragment of bone. A great deal of angulation deformity and distraction on x ray are usually acceptable, because the clavicle mends and reforms itself so well and does not have to support the body in the meantime. As with rib fractures, respiration prevents immobilization, so the relief that comes with callus formation may be delayed another week.

References


Table of Contents
from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD