CLAVICLE FRACTURE

What is a Clavicle Fracture?

A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. This type of fracture is fairly common, accounting for about 5% of all adult fractures.

Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it snaps or breaks. A broken collarbone can be very painful and can make it hard to move your arm.

Many 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.

What causes Clavicle Fractures?

Clavicle fractures are most often caused by a direct blow to the shoulder. This can happen during a fall onto the shoulder or an accident, like a car collision. A fall onto an outstretched arm can also cause a clavicle fracture. In a baby, a clavicle fracture can occur during the passage through the birth canal.

What are Clavicle Fracture symptoms?

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 the arm because of pain
A grinding sensation when you try to raise the arm
A deformity or bump over the break
Bruising, swelling, and/or tenderness over the collarbone

How are Clavicle Fractures treated?

Nonsurgical Treatment

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

Nonsurgical 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.
Physical therapy. Although there will be some pain, it is important to maintain arm motion to prevent shoulder and elbow 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 doctor may start gentle shoulder exercises. These exercises will help prevent stiffness and weakness. You will start more strenuous exercises gradually once the fracture is completely healed.

Follow-up care. You will need to see your doctor regularly until your fracture heals. During these visits, the doctor will take X-rays to make sure the bone is healing in a good position. After the bone has healed, you will be able to gradually return to your normal activities.

Complications. In some cases, a clavicle fracture can move out of place before it heals. It is important to follow up with your doctor as scheduled to make sure the bone stays in position.

If the fracture does not heal, it is called a nonunion.

In some cases of nonunion, the patient has very little pain and good motion, so no further treatment is required.
In other cases, nonunion can result in significant pain and may require an operation for repair.

If the fracture fragments do move out of place and the bones heal in that position, it is called a malunion. Surgical treatment for this is very rare, determined by how far out of place the bones are and how much this affects your arm movement.

A large bump over the fracture site may develop as the fracture heals. This usually gets smaller over time, but a small bump often remains permanently.

Surgical Treatment

If the broken ends of the bones have significantly shifted out of place, your doctor may recommend surgery.

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 shoulder strength when you have recovered.

Open reduction and internal fixation. This is the procedure most often used to treat clavicle fractures. During the procedure, the bone fragments are first repositioned (reduced) into their normal alignment. The pieces of bone are then held in place with special metal hardware.

Common methods of internal fixation include:

Plates and screws. After being repositioned into their normal alignment, the bone fragments are held in place with special screws and metal plates attached to the outer surface of the bone.

After surgery, you may notice a small patch 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.

Plates and screws are not routinely removed after the bone has healed, unless they are causing discomfort. Problems with the hardware are not common, but some patients find that seatbelts and backpacks can irritate the collarbone area. If this happens, the hardware can be removed after the fracture has healed.
Pins or screws. Pins or screws can also be used to hold the fracture in good position after the bone ends have been put back in place. The incisions for pin or screw placement are usually smaller than those used for plates.

Pins or screws often irritate the skin where they have been inserted and are usually removed once the fracture has healed.

Pain management. After surgery, you will feel some pain.This is a natural part of the healing process. Many patients find that using ice and non-prescription pain medications are sufficient to relieve pain.

If your pain is severe, your doctor may suggest a prescription-strength medication, such as an opioid, for a few days.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose have become critical public health issues. For this reason, opioids are typically prescribed for a short period of time. It is important to use opioids only as directed by your doctor and to stop taking them as soon as your pain begins to improve.

Rehabilitation. Specific exercises will help restore movement and strengthen your shoulder. Your doctor may provide you with a home therapy plan or suggest that you work with a physical therapist.

Therapy programs typically start with gentle motion exercises. Your doctor will gradually add strengthening exercises to your program as your fracture heals.

Although it is a slow process, following your physical therapy plan is an important factor in returning to all the activities you enjoy.

Complications. There are risks associated with any type of surgery. These include:

Infection
Bleeding
Problems with wound healing
Pain
Blood clots
Damage to blood vessels or nerves
Reaction to anesthesia

Risks that are specific to surgery for clavicle fractures include:

Difficulty with bone healing
Lung injury
Numbness below the clavicle
Hardware irritation

Before your surgery, your doctor will discuss each of the risks with you and will take specific measures to avoid complications.

Outcome

Whether or not your treatment involves surgery, it can take several months for your collarbone to heal. Healing may take longer in diabetics or in people who smoke or use tobacco products.

Most people return to their regular activities within 3 months of their injury. Your doctor will tell you when your injury is stable enough to do so. Returning to regular activities or lifting with your arm before your doctor advises may cause the fracture fragments to move or the hardware to break. This may require you to start your treatment from the beginning.

Once your fracture has completely healed, you can safely return to sports activities.