From the Guidelines
For a clavicle X-ray, an anteroposterior (AP) view in upright position is the most recommended view, as it provides a clear and unobstructed view of the clavicle's entire length and its articulations, allowing for accurate assessment of fractures, dislocations, and other abnormalities. This recommendation is based on the most recent and highest quality study, which suggests that upright radiographs may be superior for demonstrating the degree of displacement in midshaft clavicle fractures when compared with supine radiographs 1.
Key Considerations
- The patient should be positioned standing or sitting upright, with the arm on the affected side relaxed at their side.
- The X-ray beam should be centered on the middle of the clavicle, and the image should include the entire clavicle from the sternoclavicular joint to the acromioclavicular joint.
- In some cases, additional views may be ordered, such as a 15-degree cephalic tilt view or an apical oblique view, to help visualize specific areas of the clavicle or to evaluate certain fractures or the acromioclavicular joint.
Rationale
The AP view is preferred because it provides a clear view of the clavicle's entire length and its articulations, making it easier to detect subtle deformities or alignment issues. This view is also useful for evaluating traumatic shoulder injuries, as acromioclavicular and glenohumeral dislocations can be misclassified on other views 1.
Additional Views
While the AP view is the primary recommended view, additional views may be ordered in certain cases, such as:
- A 15-degree cephalic tilt view to help visualize the middle third of the clavicle better.
- An apical oblique view to evaluate certain fractures or the acromioclavicular joint. These additional views can provide further information and help guide treatment decisions, but the AP view in upright position remains the most recommended initial view.
From the Research
X-ray Views for Clavicle Fractures
- The apical oblique view of the clavicle is useful in detecting nondisplaced fractures of the middle third of the clavicle in neonates and children 2.
- A 20° cephalic tilt clavicle AP view in supine position is recommended to best evaluate the fractured clavicle length 3.
- Additional x-ray views, such as a 4-view radiographic series, can increase the decision to treat clavicular fractures surgically and improve intraobserver reliability 4.
- Radiographic measurements of shortening and vertical displacement in the fractured clavicle can be affected by patient positioning and projection, with upright patient positioning and caudocranial projection indicating the largest amount of shortening and vertical displacement 5.
- The distance of the clavicle in 3 dimensions and each direction can be measured, and the correlation of the angular orientation of the scapula according to each directional distance of the clavicle can be analyzed 6.