In this section
See also: Clavicle fractures - Fracture clinics
Middle third (most common)
Broad arm sling to support limb for 2 weeks or until comfortable. No evidence to support Figure of 8 bandage or brace
If age >12 years and shortened >2 cm refer to orthopaedics for opinion
Give parent fracture of the clavicle (collarbone) fact sheet. Advise to give regular analgesia as required
If <11 years and undisplaced, follow-up by a GP or fracture clinic is usually not required. Repeat x-rays are usually not required
If displaced or ≥11 years, follow up with GP or fracture clinic in 1 week
If displaced, refer to the nearest orthopaedic service on call
Fracture clinic in 5-7 days with x-ray
If displaced, urgent referral to the nearest orthopaedic on call service
To be arranged by orthopaedic service
Fractures of the clavicle can be classified by its anatomical location (Table 1):
Table 1: Classification of clavicle fractures by location.
Around and lateral to coracoclavicular ligaments
Middle third or midshaft
Defined by shortening/comminution/angulation
Bony injury alone
The clavicle is one of the most common fractured bones in children. It is the most common perinatal fracture associated with birth trauma. Half of all paediatric clavicle fractures occur under the age of seven years. These heal quickly and recover fully.
Injuries are usually the result of a fall on an outstretched hand with the force transmitted up the arm. A direct blow to the outer end of the clavicle (such as a fall onto the point of the shoulder during sporting activities or a striking injury) can be associated with distal third injuries and acromioclavicular joint disruption.
Most present with pain, swelling and deformity along the line of the clavicle, and a history of a fall. Toddlers and infants may present having been observed not using the arm, without a witnessed trauma.
Fractures of the medial third are usually the result of direct trauma to the anterior chest (such as in a motor vehicle accident), and can be associated with neurovascular, pulmonary and cardiac (rare) injuries. Careful airway protection and neurovascular assessment is required.
All fractures should be assessed using the Advanced Trauma Life Support (ATLS) principles to ensure associated and potentially significant injuries are identified.
Standard anteroposterior (AP) and AP with 15 degrees cephalic tilt x-ray of the clavicle will show the fracture in two planes and define displacement.
A CT scan may be required for medial third injuries with sternoclavicular dislocation to assess tracheal impingement and thoracic anatomy.
Figure 1: Seven year old boy with fracture of the middle third of the clavicle.
Figure 2: Undisplaced lateral third fracture of the clavicle in a 12 year old boy.
Figure 3: A) 14 year old with posterior dislocation of the medial end of right clavicle. This is difficult to see on x-ray. B) The posterior dislocation (red arrow) is more evident on CT scan.
Reduction of the middle third is almost never required. Manipulation can lead to neurovascular injury.
Displaced lateral and medial third fractures require orthopedic referral for assessment.
Open fractures, severely displaced fractures with skin at risk, or fractures with neurovascular injury may require surgical reduction and fixation. These should be referred to the orthopaedic service as a matter of urgency.
The majority of clavicle fractures are easily managed with a sling and analgesia.
Indications for prompt consultation include:
Congenital pseudoathrosis of clavicle - multiple previous fractures in same location
Type of reduction
Immobilisation method & duration
No reduction required
Broad arm sling to support limb for 2 weeks or until comfortable
No evidence to support Figure of 8 bandage or brace
Regular analgesia as required
If undisplaced, no reduction required
If displaced, urgent referral to the nearest orthopaedic service on call
Broad arm sling to support limb
Children <11 years old with undisplaced fractures do not usually require follow-up by a GP or fracture clinic. Repeat x-rays are usually not required.
For children ≥11 years old or those with displaced fractures, follow up should occur with a GP or in fracture clinic in one week with x-ray. Radiographs are usually not required. Mobilisation out of the sling commences at two weeks depending on pain control.
The majority of uncomplicated middle third fractures will have excellent functional and cosmetic outcomes.
Provide parent with fracture of the clavicle (collarbone) fact sheet.
Pain from the fracture and restriction of movement are usual for 2-3 weeks and will require regular analgesia.
The child should re-attend if pain is increasing, or sensation changes abruptly. Contact sports and activities should be avoided for approximately six weeks post removal of sling. A lump usually develops at the fracture site, which may be visible and palpable for at least one year.
See fracture clinics for other potential complications.
Hunter JB. Fractures around the shoulder and humerus. In Children's Orthopaedics and Fractures,3rd Ed. Benson M, Fixsen J, Macnicol M, Parsch K (Eds). Springer, London 2010. p.717-30.
Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev 2009; CD007121.
Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elbow Surg 2010; 19: 1049-55.
Simon RR, Sherman SC, Koenigsknecht SJ. Clavicle fractures. In Emergency Orthopaedics - The Extremities. 5th Ed. McGraw-Hill, Chicago 2007. p.285-7.
Young SJ, Barnett PL, Oakley EA. Fractures and minor head injuries: Minor injuries in children II. Med J Aust 2005; 182: 644-8.
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