The collarbone, also called the clavicle, is the bone over the top of your chest, between your breastbone (sternum) and shoulder blade (scapula). It is easy to feel the clavicle, because unlike other bones which are covered with muscle, only skin covers a large part of the bone.
Clavicle fractures are extremely common. Broken collarbones occur in babies (usually during birth), children and adolescents (because the clavicle does not complete development until the late teens), athletes (because of the risks of being hit or falling), or during many types of accidents and falls. Clavicle fractures account for between 2 and 5% of all fractures.
Symptoms of a Broken Collarbone
Most often, patients with a clavicle fracture complain of shoulder pain and difficulty moving their arm. Common symptoms of this injury include:
- Pain over the collarbone
- Deformity of the collarbone
- Swelling and bruising around the shoulder. Over time the bruising may extend down the chest and armpit.
- Difficulty raising the arm from the side
- Numbness and tingling can occur down the arm
At the doctor's office or in the emergency room, an x-ray will be obtained to asses for the specific type of clavicle fracture. Your doctor will also perform an examination to ensure the nerves and blood vessels surrounding the clavicle are in tact. The nerves and vessels are rarely injured because of a broken collarbone, but in severe cases these associated injuries can occur.
Types of Clavicle Fractures
Usually clavicle fractures are separated into three types of injuries depending on the location of the fracture:
Mid-Shaft Clavicle Fractures (75%)
The most common type of clavicle fracture is in the central third of the bone. These injuries can be a simple crack in the bone, or badly displaced. Particular concerns occur when there are multiple breaks in the bone (segmental fractures), significant displacement (separation), or shortening of the length of the bone.
Distal Clavicle Fractures (20%)
Distal clavicle fractures occur in close proximity to the end of the collarbone at the shoulder joint. This part of the shoulder is called the acromioclavicular (AC) joint, and distal clavicle fractures often have similar treatment considerations as an AC joint injury.
Medial Clavicle Fractures (5%)
Medial clavicle fractures are much less common and often have a relationship to injury to the sternoclavicular joint. One of the last growth plates to close in the body is at the medial end of the clavicle, and therefore growth plate fractures of the clavicle can be seen into the late teens and early twenties.
Treatment of Clavicle Fractures
The treatment of a clavicle fracture is accomplished either by allowing the bone to heal, or performing a surgical procedure to restore the proper alignment of the bone and hold it in position. Unlike many other fractures, some common treatments for broken bones are not appropriate for clavicle fractures. Casting a clavicle fracture is not performed. In addition, resetting the bone (called a closed reduction) is not performed because there is no way to hold the bone in alignment without performing surgery.
In making a decision about surgery, some of the following factors may be taken into consideration by your doctor:
- Location of fracture and degree of displacement of the bone (nondisplaced, or minimally displaced, fractures should be managed without surgery)
- Other injuries that may have occurred (patients with head injuries, or multiple fractures may be treated without surgery)
- Age of the patient (younger patients have a better ability to recover from fractures without surgery)
- Expectations of patient (when the injury involves and athlete, heavy laborer, or the dominant extremity, there may be more reason for surgery)
Your doctor can have a discussion with you about the pros and cons of surgery. While the vast majority of clavicle fractures can be managed without surgery, there are some situations where surgery may provider a better outcome.
Several types of supports are used for non-surgical treatment of clavicle fractures. These include a sling or figure-of-8 brace. In general, I prefer a sling, as the figure-of-8 brace has not been shown to affect fracture alignment, and patients generally find a sling more comfortable.
Healing a Broken Collarbone
Clavicle fractures should heal completely within 12 weeks, but the pain usually subsides within a few weeks. Often patients are back to full activities before 12 weeks has passed, especially with younger patients. Immobilization is seldom needed beyond a few weeks, and at that point light activity and gentle motion can usually begin.
As a general guide to return to activities, nothing should cause worsening pain. If not wearing a sling causes pain, wear a sling. If driving hurts the fracture site, don't drive. If throwing a ball hurts, don't throw. Once an activity doesn't cause significant pain, a gradual return can be attempted.
Recovery is usually complete, with a full return expected. Patients may notice a persistent bump where the fracture was (often for months or longer), but this should not be bothersome.
Jeray KJ. "Acute Midshaft Clavicular Fracture" J Am Acad Orthop Surg April 2007 vol. 15 no. 4 239-248