Clavicle fracture

Symptoms include increasing pain, redness, swelling, discharge from wound or operative site, fever. Referral should be made to an orthopedic surgeon.

If the patient sustains additional trauma, is not compliant with treatment, or the fracture is unstable, then new or additional displacement may occur. This may manifest as increasing pain, new deformity, new skin tenting, increased crepitus, and/or new functional impairment. Clinical exam and repeat imaging (plain x-rays and comparison with prior films usually suffice) should enable accurate diagnosis.

Healing of the fracture in an abnormal position with a possible palpable and noticeable bump at the healed fracture site. Generally asymptomatic.

Persistent pain and tenderness at the fracture site raise the suspicion of nonunion. Obtain plain x-rays if nonunion is suspected.

It is possible that neurovascular injury was present initially but not detected, or a new neurovascular injury may develop due, for example, to fracture displacement or additional injury. If the patient exhibits new or worsening paresthesias, dysesthesias, numbness, weakness, pallor, or cool digits, urgent clinical exam with a thorough neurovascular assessment is necessary.

Doppler ultrasound and/or CT/MR angiography can be performed as appropriate to detect vascular injury. MRI of the brachial plexus can help identify brachial plexus injury early on, whereas electrodiagnostic testing (electromyography and nerve conduction velocity) usually does not show significant abnormalities until around 3 weeks after injury.