A 4 yo M presents to Urgent Care with R shoulder pain after a fall off his bed. Father denies any head trauma or other injury. On exam, he has decreased ROM at the R shoulder and tenderness and ecchymosis along the distal/mid clavicle. Neurovascular exam is normal. An xray is done and shown below. What's the diagnosis?  (scroll down for answer) 

Answer: Acute fracture of the R mid clavicle with minimal inferior displacement

• Etiology:
• Most commonly caused by fall onto shoulder (85%), less commonly fall onto outstretched hand
• Presentation:
• patients typically present w/ guarding/favoring of affected arm
• may see gross deformity, focal tenderness, swelling or ecchymosis of the clavicle
• pain is worse w/ ROM
• Diagnosis:
• often diagnosed by history and physical exam
• plain radiography
• Allman System used to classify clavicle fractures based on location:
• Group I- middle third clavicle fracture (80%)
• Group II- distal third clavicle fracture (10-15%)
• Group III- proximal third clavicle fracture (5%)
• ED management:
• must perform neurovascular exam due to close proximity to brachial plexus and subclavian vessels
• non-displaced (or minimally displaced) fractures are often managed non-operatively 
• operative management determined by location, stability and degree of displacement
• orthopedic referral
• emergent surgical consult for airway or great vessel involvement

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