Missed lateral end clavicle fracture in adolescent patients: The value of undertaking additional clavicle radiographic views

Clavicle fractures are extremely common, accounting for 5%-10% of all pediatric fractures. Due to the increased radiation dose, additional radiographic views are less frequently performed, particularly in skeletally immature patients. In Trauma and Orthopedic practice, it is well known that 2 radiographic views are essential for any fracture assessment, with additional views such as oblique views for selected cases. Oblique views are recommended, especially for extremity trauma as this has shown to reduce the incidence of missed diagnoses. Although 2 views of the clavicle, A-P and 45° cephalic tilt are recommended, it is the usual practice in most radiology departments to undertake A-P view of clavicle only. We report a case of a lateral end displaced clavicle fracture in a 16-year-old sustained following football injury. This was completely missed at the initial encounter and the patient later presented with pain and difficulty to move his right shoulder. We believe if this patient had a 45° cephalic tilt view at the time of presentation, the fracture would have been identified and appropriate treatment would have been instituted. Awareness of obtaining a minimum of 2 radiographic views for lateral clavicle fractures will reduce the incidence of missed clavicle fractures.