71.4 Fractures of the clavicle

The clavicle often breaks, especially in a child. He crys when he moves his arm, but there may be little to suggest that he has broken his clavicle. Feel carefully, and you will find an area of tenderness but no swelling. The fracture may be greenstick and difficult to see on an X–ray. Sometimes there is a swelling without any history of injury.

If an adult breaks the middle third of his clavicle, his sternomastoid muscle pulls the medial fragment up, while the weight of his arm pulls the lateral one down. Often there is a third middle fragment. If the fracture is lateral to his co­ra­co–clavicular ligament, the medial end of his clavicle is little displaced, because these ligaments hold it. If it breaks medially to the ligaments, its outer end may appear to be displaced backwards and upwards, so that it forms a lump under his skin. Without an X–ray these fractures are difficult to distinguish from subluxation of the acromio–clavicular joint.

Treat all fractures of the clavicle with a sling and active movements, as in Section 71.2.

The clavicle almost always unites with no loss of function, and although the patient has a lump, this will disappear in a child and usually does so in an adult. If it is unslightly, it can be removed.

Figure 71.3: DISLOCATION OF THE ACROMIO–CLAVICULAR JOINT. A, shows the characteristic deformity of the shoulder. B, shows the method of strapping it.