Clavicle Fractures (Broken Collarbone)

Overview

Most clavicle fractures occur by a fall onto the shoulder or an outstretched arm. A broken collarbone can be very painful and can make it hard to move your arm.

In most cases, clavicle fractures can be treated by wearing a sling to keep the arm and shoulder from moving while the bone heals. With some clavicle fractures, however, the pieces of bone move far out of place when the injury occurs. For these more complicated fractures, surgery may be needed to realign the collarbone.

Causes & Symptoms

Clavicle fractures are most often caused by a direct blow to the shoulder. This can happen during a fall onto the shoulder or a car accident. A fall onto an outstretched arm can also cause a clavicle fracture. They are common injuries sustained falling from a bicycle, or during sports like playing rugby or skiing.

A clavicle fracture can be very painful and may make it hard to move your arm. Other signs and symptoms of a fracture may include:

• Sagging of the shoulder downward and forward
• Inability to lift your arm because of pain
• A grinding sensation when you try to raise your arm
• A deformity or "bump" over the break
• Bruising, swelling, and/or tenderness over the collarbone
   

Diagnostics

A careful examination will determine the site of the injury, insure that the fracture fragments have not pierced the skin and ensure that no blood vessels or nerves are damaged.

X-rays are usually all that is required to make the diagnosis and help decide on the best form of treatment. Occasionally a CT scan may be helpful but usually only to assess for healing later in the management of this injury.

Treatments

If the broken ends of the bones have not significantly shifted out of place, you may not need surgery. Most broken collarbones can heal without surgery.

Non-surgical treatment may include:

• Arm support – a simple arm sling is usually used for comfort immediately after the break and to keep your arm and shoulder in position while the injury heals.
• Medication – pain medication, including acetaminophen, can help relieve pain as the fracture heals.
• Physiotherapy - although there will be some pain, it is important to maintain arm motion to prevent stiffness. Often, patients will begin doing exercises for elbow motion immediately after the injury. 

After a clavicle fracture, it is common to lose some shoulder and arm strength. Once the bone begins to heal, your pain will decrease and your consultant may recommend gentle shoulder exercises. These exercises will help prevent stiffness and weakness. More strenuous exercises will be started gradually once the fracture is completely healed.

Surgery may be needed if the broken ends of the bones have significantly shifted out of place:

Surgery typically involves putting the broken pieces of bone back into position and preventing them from moving out of place until they are healed. This can improve the success of healing and improve shoulder strength and function when you have recovered.

The procedure most often used to treat clavicle fractures is known as an open reduction internal fixation. During this procedure, the bone fragments are first repositioned into their normal alignment. The pieces of bone are then held in place with special screws and metal plates attached to the outer surface of the bone.

After surgery, you may notice a small area of numb skin below the incision. This numbness will become less noticeable with time. Because the clavicle lies directly under the skin, you may be able to feel the plate through your skin.

Aftercare & Recovery

Fractures will usually unite over a 6-8 week period, however, your shoulder should feel much more comfortable after as little as 2-3 weeks, particularly if surgery has been performed. Plates and screws are not routinely removed after the bone has healed, unless they are causing discomfort.