Clavicle (fracture)

Clavicle fractures are the most common upper limb accounting for about 35% injuries to the shoulder girdle (1)

• accounts between 2.6% - 4% of all adult fractures
• annual incidence is estimated to be between 29- 64/100,000 population per year (1)
• there are two reported peaks of incidence, the first (and largest) is in young active males while the second is in elderly individuals with a slight female predominance (2)

Clavicular fractures are usually caused by trauma (except for rare pathologic fracture due to metastatic or metabolic disease) (3). Shaft fractures are common in young adults while lateral and medial end fractures are frequently seen in elderly people (1)

• in children and young adults, moderate to high energy mechanisms such as motor vehicle accidents or sports injuries (especially in contact sports such as football and rugby) are responsible
• in elderly individuals, a sequelae of low-energy falls are more likely to be the cause
• mechanism of clavicular injury include:
  • most common way of clavicle fracture is when a person falls directly on the shoulder with the arm at the side.
  • less commonly fractures can occur from a direct blow or from a fall on an outstretched hand (violent upwards and backwards force as might be sustained by landing on the outstretched hand after being thrown from a horse or over the handlebars of a bicycle) (4)
• sites:
  • most commonly, along the middle one-third, frequently, at the middle one-third / outer one-third junction
  • less commonly, within the outer one-third; these may be severely displaced if associated with a coracoclavicular tear

Reference:

• (1) Khan LA et al. Fractures of the clavicle. J Bone Joint Surg Am. 2009;91(2):447-60.
• (2) Faldini C et al. Nonoperative treatment of closed displaced midshaft clavicle fractures. J Orthop Traumatol. 2010;11(4):229-36.
• (3) Toogood P et al. Clavicle fractures: a review of the literature and update on treatment. Phys Sportsmed. 2011;39(3):142-50.
• (4) Pecci M, Kreher JB. Clavicle fractures. Am Fam Physician. 2008;77(1):65-70.