CASE 1897 Published on 03.03.2003

Fracture of the medial third of the clavicle


Musculoskeletal system

Case Type

Clinical Cases


N.M. Mohsin


14 years, male

No Area of Interest ; Imaging Technique CT
Clinical History
Fall onto the left shoulder whilst playing football. Pain and tenderness over the sternoclavicular joint.
Imaging Findings
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.

Differential Diagnosis List
Fracture of the medial third of the clavicle
Final Diagnosis
Fracture of the medial third of the clavicle
Case information
DOI: 10.1594/EURORAD/CASE.1897
ISSN: 1563-4086