Diagnosis

The diagnosis can first be established clinically on the basis of descriptions of the parents and the child about the accident and the localization of the pain By looking at the child, the treating physician can often make a good diagnosis. On the side where the collarbone fracture is present, the child usually holds the arm in a relieving position. In this position, the arm is placed close to the body and the forearm is held in front of the abdomen with the other hand.

Often the shoulder on the affected side is also visibly lower. Fractures (fractures) that are more pronounced show a step formation on the collarbone. This results from a tear in the ligamentous apparatus of the collarbone.

Normally, the clavicle is pulled caudally (below) by these ligaments – in the event of rupture of these ligaments or a fracture of the clavicle, in which the ligaments no longer stabilize the entire bone, the trapezius muscle at the clavicle is pulled more strongly cranially (above).The clavicle can be dislocated upwards (protrudes) and pressed caudally (downwards); this is known as the piano key phenomenon. A clavicle fracture is usually palpable for the doctor. In this case, the physician can palpate irregularities and fracture gaps by means of a structured palpation of the clavicle.

Fractures in which the skin is visibly pierced by the bone can often be diagnosed very quickly. However, a complete clinical examination should also be performed in this case to exclude possible concomitant injuries. The clinical examination, which should not be neglected, includes palpation and assessment of adjacent structures (such as ribs and shoulder blade).

Furthermore, it must be absolutely excluded that no nerves and vessels have been affected. Ultrasound is the method of choice for further diagnosis. In infants under 2 years of age, this method is usually sufficient to visualize a collarbone fracture.

In older children and adolescents, it is usually important to perform an X-ray or computed tomography examination in order to be able to describe the degree of dislocation more precisely. During the X-ray examination, the child holds a weight of about 5 – 10 kg in his hand. Due to the traction on the arm, a dislocation of the clavicle fracture is better visualized. As a rule, computed tomography should only be performed if the fracture cannot be adequately visualized in any other way. Here too, children should be exposed to as little radiation as possible.