The clavicle forms an "S" shape between the sternum and the acromion, serving as the only bony connection between the upper limbs and the trunk. Located just beneath the skin and superficial in position, the clavicle is prone to fractures when subjected to external force, accounting for 5–10% of all fractures in the body. These fractures most commonly occur in children and young adults.

bubble_chart Etiology

Indirect violence often causes fractures, such as when falling with the hand or elbow hitting the ground, where the force travels from the forearm or elbow upward along the arm toward the proximal end. Landing on the shoulder is even more common, impacting the outer end of the clavicle and causing a fracture. Fractures caused by indirect violence are mostly oblique or transverse, frequently occurring at the middle and outer third of the bone. Fractures caused by direct violence vary depending on the point of impact and are often comminuted or transverse. In children, greenstick fractures are more common. The typical displacement of a clavicle fracture usually presents as: the proximal end pulled upward and backward by the sternocleidomastoid muscle, while the distal end shifts forward, downward, and inward due to the weight of the limb and the pull of the pectoralis major muscle, resulting in shortening and overlapping displacement of the fractured ends.

bubble_chart Clinical Manifestations

Local swelling, subcutaneous static blood, tenderness, or deformity may be present. The displaced fracture ends can be palpated at the deformity site. If the fracture is displaced and overlapped, the distance between the acromion and the sternal end becomes shorter. The affected limb has limited function, with the shoulder drooping and the upper arm pressed against the chest, unwilling to move, while the healthy hand supports the affected elbow. In children with greenstick fractures, the deformity is often not obvious, and they may not be able to describe the pain location. However, their head tends to tilt toward the affected side, and the chin turns toward the healthy side, which aids clinical diagnosis. Sometimes, fractures caused by direct violence may puncture the pleural membrane, leading to pneumothorax, or injure the subclavian vessels and nerves, resulting in corresponding symptoms and signs.

A history of trauma such as falling with the upper limb abducted or direct violent impact to the local area, followed by shoulder pain and inability to move the affected limb. X-rays can confirm the diagnosis and reveal the displacement and comminution of the fracture.

bubble_chart Treatment Measures

1、Suspension of the affected limb

For greenstick fractures, incomplete fractures, or fractures of the inner third with minimal displacement, suspend the affected limb with a triangular bandage or a neck-wrist sling for 1–2 weeks. Begin functional exercises once the pain subsides.

2、Reduction and fixation

For displaced fractures, perform manual reduction and fix with an "8"-shaped gypsum for 4–5 weeks (Figure 3-8-2). If the affected limb experiences numbness, pain, swelling, or pallor, re-examine promptly and make necessary adjustments to the gypsum fixation.

3、Surgical treatment

Indications for surgical treatment: open fractures; fractures combined with vascular or nerve injuries; fractures of the outer end or outer third of the clavicle with coracoclavicular ligament rupture; nonunion fractures. The method of internal fixation may vary depending on the type and location of the fracture, including options such as "8"-shaped wire, Kirschner wire, or plate and screw fixation.