Distal clavicle fracture

Case contributed by Weiling Tan

Presentation

Patient was seen for persistent right shoulder pain, query right acromioclavicular joint subluxation.

Patient Data

Age: 60 years
Gender: Male

Initial radiographs

X-ray

An angular deformity is seen over the distal end of the clavicle in the anterioposterio shoulder view. A cortical step is better appreciated in the anterior portion of the distal end of the clavicle, in the axial view. 

The patient presented at the A&E for a second opinion for persistent pain over the shoulder.

Right shoulder (after 2 days)

X-ray

Fracture of the distal clavicle seen, better demonstrated on the outlet view, as well as axial view. 

Zanca view

X-ray

Fracture of the right distal clavicle with superior displacement is demonstrated. The right acromioclavicular alignment is grossly maintained.

Case Discussion

The fracture of the distal clavicle was seen in the shoulder views. However, the displacement of the fracture was better demonstrated on the zanca view. 

The zanca view is performed with a 15 degree cranial angulation, towards the acromioclavicular joint. The slight angulation allows for a better appreciation of the acromioclavicular joint, and in this case, the distal end of the clavicle in demonstration of the fracture displacement. 

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