Clavicle Fracture

Clavicle fractures are common and usually occur with direct trauma to the shoulder or directly over the bone, such as falling off a bicycle or onto the shoulder during a tackle in a football game. Fractures most often occur in the middle of the bone, where the bone is the thinnest. These fractures are usually seen in the active population, in both pediatric and adult ages.

Anatomy

The clavicle, or collarbone, sits at the front of the shoulder between the breastbone (sternum) and the shoulder blade (scapula). Muscles from the neck attach to the clavicle. Some important nerves and vessels lie just behind the collarbone, but these structures are usually not injured during a clavicle fracture.

Fracture Types

Fractures are classified by their pattern and associated injuries. Fractures can be simple, meaning a single fracture line without very much movement of the two ends of the bone on either side of the fracture. Fracture lines may be vertical, oblique, like a diagonal line on an x-ray, or spiral-shaped. Fractures with more than one fracture line are described as comminuted.

Displacement is the movement of the fracture pieces away from each other. The further the displacement, the more difficult it is for the bones to heal. Very displaced fractures may need surgery to realign and stabilize the fracture. Most clavicle fractures that occur in the middle or middle third of the bone tend to displace predictably due to how the muscles attach to the collarbone.

In high-energy injuries, such as a car crash, the fracture may also be associated with an open wound around the break, usually caused by the fractured bone poking through the muscle and skin. Fractures with an associated open wound are called Open Fractures. These injuries are emergencies and almost always need urgent surgery. These high-energy injuries may also have associated rib fractures, lung injuries, head trauma, or fractures in other parts of the body.

Fractures closer to the end of the clavicle can be associated with ligamentous injuries, usually around the structures that attach the shoulder blade (scapula) to the clavicle.

Symptoms

Pain over the collarbone and shoulder
There may be an audible pop or snap during the time of injury
Limited shoulder movement
Bump or open wound over the collarbone
Bruising or swelling over the clavicle
Sagging of the shoulder

Evaluation

A medical practitioner will ask about the injury and how it occurred. They will look at the collarbone and shoulder to evaluate for deformity, wounds, bruising, and swelling. They will assess the arm to check muscle and skin nerve function.

In most cases, x-rays are the best way to evaluate clavicle fractures. CT scans may provide more detailed images of fractures if the fractures are complex.

MRIs are usually not ordered but can be helpful if there are suspected injuries around the collarbone.

Treatment

Most clavicle fractures can heal without surgery, especially in younger patients. Some fractures that are displaced can heal well without surgical intervention.

Treating a clavicle fracture without surgery usually includes support of the affected arm, usually a sling. While the fracture is healing, the patient is usually asked to limit the use and weight lifting of the affected arm. X-rays will be ordered periodically to assess the fracture positioning and healing. Once the bones are healed, physical therapy may help regain strength and function in the shoulder.

Fractures that may need surgery include complex fractures with multiple fracture lines, very out of place, open fractures, or fractures that fail to heal with conservative management. During surgery, the fracture will be repositioned and held together with metal such as plates and screws. After surgery, there may be a temporary period of limited use of the affected arm until the fracture heals. Physical therapy is often helpful in regaining function and strength in the shoulder.