Fall onto the left shoulder whilst playing football. Pain and tenderness over the sternoclavicular joint.
The patient presented after a fall onto the left shoulder whilst playing football. There was pain and tenderness over the the sternoclavicular joint.
Radiographs of the clavicle revealed a fracture of the medial aspect of the clavicle and the possibility that there was extension of the fracture into the sternoclavicular joint with possible dislocation (Fig. 1). Therefore a CT scan was performed.
The CT scan confirmed a comminuted fracture of the medial end of the clavicle with relative superior displacement of the lateral part of the clavicle (Fig. 2a). The sternoclavicular joint was intact (Fig. 2b). There was soft tissue swelling around the medial part of the left clavicle but there was no evidence of mediastinal or intra-thoracic injury (Fig. 2c).
Approximately 75-80% of clavicular fractures involve the middle third of the bone. Fractures of the medial third of the clavicle are the rarest, comprising 5% of all clavicular fractures, and are usually due to direct trauma.
Intra-articular fractures may be overlooked unless computed tomography is used. They can result in secondary osteoarthritis with persistent pain.
Fractures of the middle third, with or without sternoclavicular dislocation, can lead to vascular injury and this should raise clinical suspicion and lead to a low threshold for radiological investigation. Vascular laceration is an early complication of fracture of the clavicle and it can result in a relatively high morbidity and even mortality.
Fracture of the medial third of the clavicle
Based on the provided shoulder X-ray and CT images, a fracture in the medial segment of the left clavicle near the sternoclavicular joint is observed. The specific indicators include:
Taking into account the patient’s age (14 years), mechanism of injury (fall), clinical symptoms (local pain and tenderness around the sternoclavicular region), and imaging findings (clear fracture line in the medial segment with partial displacement), the most likely diagnosis is:
If further clarification on intra-articular involvement and evaluation of vascular and nerve placement is needed, more detailed CT or vascular imaging studies can be considered.
For medial clavicle fractures, treatment strategies depend on fracture stability, degree of displacement, and whether there is any involvement of vascular, nerve, or other critical structures. The following are general recommendations:
F (Frequency): Begin with 2-3 times per week and adjust according to pain and recovery status.
I (Intensity): Focus on small range-of-motion and low-load exercises during the early fracture phase. Gradually increase resistance in later stages.
T (Time): Start with 10-15 minutes per session, then increase to 20-30 minutes as tolerated.
T (Type): Begin with passive range-of-motion and pendulum exercises, progressing to active mobility, stretching, and light resistance training. A suggested phase-wise approach:
V (Volume) & P (Progression): Increase exercise complexity, duration, and load gradually as pain decreases and function improves.
During rehabilitation, closely monitor any changes in pain, swelling, or range of motion on the injured side. If significant swelling, severe pain, or loss of function occurs, seek prompt medical evaluation.
The above report is solely an interpretive analysis based on current imaging and available information. It does not replace a professional medical diagnosis or in-person evaluation. If you have further questions or if your condition changes, please visit a hospital and consult a qualified medical professional promptly.
Fracture of the medial third of the clavicle
