Injury to the left shoulder following a fall.
The patient, a right-handed bricklayer, tripped and fell forward, injuring his left shoulder. There was no history of any other injuries or significant past medical illness.
On examination, there was mild swelling and tenderness over the left clavicle. There were no skin injuries. The left shoulder was not tender but movements were reduced due to pain over the clavicle. The rest of the upper limb and the cervical spine were normal.
Radiographs of the left shoulder revealed a segmental fracture of the shaft of the clavicle (Figs 1, 2). Line diagram of the left clavicle fracture is shown in Fig 3.
The patient steadfastly refused any surgical intervention. The fracture was treated symptomatically in a cuff and collar, followed by physiotherapy four weeks later. The patient was reviewed at two weeks, six weeks, and three months. There was satisfactory healing of the fractures clinically and radiographically. He was back to work by three months. At six-month follow-up the patient was asymptomatic and had full range of movement of the left shoulder. The skin over the left clavicle was not tethered and no bony spike was palpable.
Clavicular fractures are the most common upper limb fractures. Even though the clavicle is a long bone, segmental fracture of the clavicle is an uncommon fracture. There have been anecdotal reports of this type of fracture, and there are reports of a type of variant of these injuries in the form of a fracture of the clavicle associated with dislocation of at either end (1, 2). Usually these fractures are due to high energy injuries (3). Management of these fractures is not easy. Plate fixation requires a long incision and significant stripping of periosteum. Wire or pin fixation can be tricky, as the clavicle is curved, and such fixations are usually limited to the outer half of clavicle (4).
This case is presented to show that segmental fracture of the clavicle, which is usually a high energy injury, can also occur in simple falls. Management of these fractures should be individualised depending on the sites of fracture and patient requirements.
Segmental fracture of the left clavicle
From the provided left shoulder X-ray, a clear discontinuity of the bone cortex in the left clavicle is observed, presenting multiple fracture fragments consistent with a segmental fracture (segmental fracture) of the clavicle. The fracture lines are located around the mid-clavicle and slightly closer to the lateral end, with relative displacement between them. No large area of soft tissue swelling is evident, but a localized increase in soft tissue shadow suggests a certain degree of soft tissue contusion or swelling. No apparent fractures of the acromion or the proximal humerus are seen.
Based on the patient’s age, history of trauma, and imaging findings, the following potential diagnoses are considered:
Considering the patient’s history of trauma (fall causing left shoulder injury), imaging findings (multiple fracture lines in the clavicle), and typical presentation of a segmental clavicle fracture, the most likely diagnosis is: Left Segmental Clavicle Fracture.
Management of a segmental fracture of the clavicle depends on the fracture location, degree of displacement, patient’s functional needs, and overall health. The main treatment approaches include:
Rehabilitation/Exercise Prescription: In the early stages of fracture healing, shoulder movement should be relatively restricted (with conservative or postoperative internal fixation). As the fracture stabilizes, gradual progression under professional guidance is recommended, following the FIT(T)-V(P) principle:
Special considerations: For patients over 55 years of age, or those with low bone density or chronic diseases (such as poor cardiopulmonary function), exercise intensity and modality should be further individualized in consultation with specialist physicians, carefully monitoring fracture healing and cardiopulmonary tolerance.
This report provides a reference analysis based on the available medical history and imaging data. It does not replace an in-person diagnosis, physical examination, or professional medical advice. If you have further questions or require a more precise treatment plan, please consult with an orthopedic surgeon or rehabilitation specialist for customized treatment and rehabilitation guidance.
Segmental fracture of the left clavicle
