CLAVICLE FRACTURE

A 28-year-old woman presents to the emergency department after a fall from a horse. The emergency department doctor has diagnosed a clavicle fracture from this radiograph.

 

1. How would you treat this injury in the emergency department?

I would take a careful history and examine the patient, looking for signs of any open wound, significant soft tissue contusion, degloving, threatened or tented skin and any associated injuries. I would look closely for any neurovascular injury. I would ensure that the patient had sufficient analgesia and would advise that they rest the upper limb in a polysling. I would review the radiograph for displacement, com- minution and fracture pattern, and, if required, repeat this to ensure that I had a representative AP and tilted view (30-degree cephalad) to make this assessment.

 

2. What advice would you give this patient about treatment options?

I would advise this patient that the vast majority of these fractures will heal satisfac- torily. For a closed fracture pattern such as this in a fit and healthy patient I would advise the use of a simple sling and analgesia for comfort and that this can be dis- continued once pain allows.

I would warn the patient that there is a risk that the fracture may not unite and this is of the order of 15% or so. I would advise that surgery can reduce this risk of non-union to approximately 3% and may allow an earlier return to work or func- tion, but surgery does introduce other risks such as infection, injury to nerves and blood vessels, painful or prominent metalwork, the need for further surgery, anaes- thetic risk, and there will be a scar, which may be sensitive.