Clavicle Fracture
What Is a Clavicle Fracture?
The clavicle (collarbone) is an S-shaped bone at the top of the chest that connects the breastbone (sternum) to the shoulder blade (scapula). It is an important link and support point between the arm and the trunk and partly protects the vessels and nerves that run beneath it. A blow to the shoulder girdle or a fall onto an outstretched hand or shoulder can break this bone.
A clavicle fracture is one of the common fractures in adults and mostly heals without surgery. Treatment and the expected recovery depend on its location. For other problems of the shoulder girdle you can review the shoulder page.
Types of Fracture
Clavicle fractures are classified by which part of the bone is broken; this affects the treatment decision.
- Mid-shaft (middle-third) fractures: the most common type; this is the thinnest and most stressed part of the bone.
- Lateral (distal) fractures: at the end near the shoulder blade; some types can be unstable.
- Medial (proximal) fractures: at the end near the breastbone; these are rarer.
How Does It Happen? Who Is at Risk?
The fracture usually results from a direct blow to the shoulder girdle or a fall onto an outstretched hand or shoulder. Some groups are at higher risk.
- People in contact and high-impact sports (football, cycling, skiing, wrestling) and young men.
- Children and adolescents in the growing years, whose bones are more prone to a blow.
- Older people with reduced bone density, in whom even a minor fall can cause a fracture.
Symptoms
A clavicle fracture usually causes obvious symptoms at the moment of injury.
- Sudden, severe pain over the collarbone and difficulty moving the arm.
- Swelling, tenderness and, over time, bruising at the fracture site.
- A visible bump or deformity in the skin and the shoulder drooping down and forward.
- Tightness or, rarely, tenting of the skin, and numbness or weakness in the arm or hand, which need urgent assessment.
Diagnosis: Examination and Imaging
Diagnosis begins with the history and physical examination; the location of the fracture, the state of the skin and the nerve and blood-vessel findings in the arm and hand are assessed.
An X-ray confirms the diagnosis and shows the type of fracture and the degree of displacement. In lateral-end fractures or where an accompanying injury is suspected, CT may be used for a detailed assessment. Whether other structures of the shoulder girdle are affected is also checked. An acromioclavicular (AC) joint injury, which can cause pain in a similar area, is also distinguished by examination and imaging.
Non-Surgical Treatment
The large majority of minimally displaced mid-shaft fractures heal without surgery. The aim is to protect the fracture, manage pain and prevent stiffness of the shoulder. Because the clavicle has a good blood supply, most fractures unite on their own with appropriate support.
- Supporting the arm and protecting the fracture with a sling (a figure-of-eight bandage in some cases).
- Cold application for pain and swelling and pain medication on medical advice.
- Gradual range-of-motion work as pain settles, and then exercises that strengthen the shoulder girdle.
When Is Surgery Needed?
Surgery is not needed for every clavicle fracture. It is considered in significant displacement and shortening, a risk of the bone tenting the skin (an open fracture), comminuted fractures, unstable lateral-end fractures and fractures that do not unite with non-surgical treatment (non-union). The decision weighs the features of the fracture together with the patient's age, activity level and expectations.
In surgery the fracture fragments are brought into alignment and fixed with a plate and screws or, in suitable cases, a nail. For the scope of the operation and the recovery process you can review the clavicle fracture surgery page.
Recovery and Return to Sport
Recovery time varies with the type of fracture, age and treatment; union of the bone usually takes weeks and is faster in children than in adults. Physiotherapy is important for restoring range of motion and muscle strength.
Return to activity and sport is guided by criteria rather than a fixed date: union of the fracture, pain-free movement and adequate muscle strength. An early return to contact sports raises the risk of a repeat fracture.
Exercise and Rehabilitation
The aim of rehabilitation is to prevent shoulder stiffness while the fracture is protected and to restore strength once it has united. The programme progresses gradually according to the patient's situation and the treatment.
- Early phase: preserving elbow, wrist and hand movement while in the sling; gentle shoulder movement within the limits of pain.
- Middle phase: widening the range of motion of the shoulder as union progresses.
- Advanced phase: progressive strengthening of the shoulder girdle and scapular muscles and a controlled return to activity.
When Should You See a Doctor?
Any suspected clavicle fracture needs assessment; some findings are an emergency.
- After a fall or blow there is severe pain, swelling or an obvious deformity over the collarbone.
- There is tightness or a risk of the skin being pierced, or numbness or weakness in the arm or hand; go to the emergency department without delay.
- Pain persists despite non-surgical treatment, union is delayed, or there is ongoing pain and abnormal sensation with movement at the fracture site.
For the assessment and treatment of a clavicle fracture you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within shoulder surgery.