History

The patient will complain of pain involving the affected shoulder and will typically hold the arm in adduction and internal rotation, avoiding any motion. There may be swelling, discoloration, and deformity at the fracture site. Displaced fractures may cause visible tenting of the skin.

X-Ray

Image not available.

Clavicle midshaft fracture. (Reproduced with permission of Justin Montgomery, MD; University of Kentucky Radiology.)

 

Nonsurgical management is the treatment of choice for most clavicle fractures and involves a sling for comfort, analgesics, and avoidance of overhead activity. This includes minimally displaced midshaft fractures as well as the vast majority of lateral and medial one-third fractures.

Indications for operative management include open fractures, fractures that compromise the airway or neurovascular structures, the presence of significant displacement and/or tenting of the skin, or a floating shoulder.

Radiographs should be obtained at 2-week follow-up to assess for displacement and angulation. Visible callus typically forms between 4 and 6 weeks, coinciding with significant clinical improvement. Once the fracture is clinically and radiographically healed, radiographs can be discontinued. The patient may return to normal activity when the clavicle is painless, the fracture is healed on radiograph, and the shoulder has a full range of motion and near-normal strength. Noncontact sports may often be resumed at 6 weeks, but return to contact sports may require ≤4 months.

Pecci  M, Kreher  JB. Clavicle fractures. Am Fam Physician. 2008;77(1):65–70.
Van der Meijden  OA, Gaskill  TR, Millet  PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg. 2012; 21:423–429.

 

 

 

 

The typical mechanism of injury is a fall on an outstretched arm or a direct blow to the shoulder or clavicle.

The patient will complain of pain involving the affected shoulder and will typically hold the arm in adduction and internal rotation, avoiding any motion. There may be swelling, discoloration, and deformity at the fracture site. Displaced fractures may cause visible tenting of the skin.

 

 

 

Clavicle fractures (Figure 39-1) are relatively common, accounting for 2–5% of all fractures in adults.

 

The typical mechanism of injury is a fall on an outstretched arm or a direct blow to the shoulder or clavicle. The patient will complain of pain involving the affected shoulder and will typically hold the arm in adduction and internal rotation, avoiding any motion. There may be swelling, discoloration, and deformity at the fracture site. Displaced fractures may cause visible tenting of the skin.

 

Complications of Injecting Drug Use

  • Local problems—Abscess (Figures 240-2 
    Image not available.

    A 32-year-old woman with type 1 diabetes developed large abscesses all over her body secondary to injection of cocaine and heroin. Her back shows the large scars remaining after the healing of these abscesses. (Courtesy of ­Richard P. Usatine, MD.)

    and 240-3; Abscess), cellulitis, septic thrombophlebitis, local induration, necrotizing fasciitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (e.g., broken needle parts) in local areas.2
    • IDUs are at higher risk of getting methicillin-resistant Staphylococcus aureus(MRSA) skin infections that the patient may think are spider bites (Figure 240-4).
    • Some IDUs give up trying to inject into their veins and put the cocaine directly into the skin. This causes local skin necrosis that produces round atrophic scars (Figure 240-5).
  • IDUs are at risk for contracting systemic infections, including HIV and hepatitis B or hepatitis C.
    • Injecting drug users are at risk of endocarditis, osteomyelitis (Figures 240-6and 240-7), and an abscess of the epidural region. These infections can lead to long hospitalizations for intravenous antibiotics. The endocarditis that occurs in IDUs involves the right-sided heart valves (see Chapter 50, Bacterial Endocarditis).2 They are also at risk of septic emboli to the lungs, group A β-hemolytic streptococcal septicemia, septic arthritis, and candidal and other fungal infections.

 

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