A 60 yo male slipped on ice and fell onto his right shoulder.  He complains of pain in the right shoulder and has obvious deformity of the right clavicle on exam.  There is no skin tenting and he is neurovascularly intact.  X-ray is shown.  What's the diagnosis?  Scroll down for answer.

Answer:  Comminuted displaced fracture of the mid shaft right clavicle

• Indications for surgical reapair - absolute -  tenting, open fracture, vascular (subclavian artery or vein) injury, floating shoulder (concomitant scapula fracture)
• Indications for surgical repair - controversial -  displaced fracture with > 2cm shortening, bilateral displaced clavicle fractures, brachial plexus injury
• Non-operative management includes immobilization with a sling or figure-of-8 dressing

Reference:  Najaria SL, “Shoulder and Humerus Injuries.” Tintinalli’s Emergency Medicine Manual, 8e. Eds Rita K Cydulkla et al. McGraw Hill, 2016.