Clavicle Fractures

The clavicle, also known as the collar bone, provides attachment between the axial skeleton and the appendicular skeleton. It also keeps the shoulder appropriately spaced out from the body to provide adequate muscle tension to move the shoulder through a full range of motion. It also is a site of multiple muscle attachments and serves to protect important neurovascular structures.

Clavicle fractures make up roughly 10% of all fractures.  Clavicle fractures are often described as distal, middle, and medial third clavicle fractures with each type of fracture occurring at different frequencies based on age and gender. Approximately 75-80% of all clavicle fractures are middle third fractures and tend to occur in the younger (<30 yo) male population after a fall on an outstretched hand or direct trauma to the shoulder.

Symptoms

Clavicle fractures can be very painful and make it hard to move your shoulder and arm. Additional symptoms include:

• Sagging shoulder (down and forward)

• Inability to lift the arm because of pain

• A grinding sensation if an attempt is made to raise the arm

• A deformity or “bump” over the break

• Bruising, swelling, and/or tenderness over the collarbone

Treatments

Your orthopedic team will assess the X-rays of your clavicle to determine the best treatment option. Treatment considerations include fracture location, amount of displacement, surrounding ligament integrity, amount of bony overlap, fracture stability, neurovascular involvement, patient age and activity level, and underlying medical conditions.

Surgical Fixation

If surgery is determined as the best course of treatment, your orthopedic team will review different fixation options. The most common is an open reduction and internal fixation (ORIF) using plates and screws. This option provides for good bony alignment and stable fixation of the fracture. Also, if a patient is wanting to return to sport, surgical fixation can hasten the return to play timeline. After an ORIF, the patient may feel a patch of numbness just below the incision due to cutting of sensory nerves. Over time, this area of numbness tends to diminish and may completely resolve. It is common, however, to have a small patch of numbness below the incision and the patient may feel a slight prominence from the plate beneath the skin. Generally speaking the plate does not cause any issues and the hardware will stay in without needing to be removed. However, in a small population of patients, the plate can cause some irritation while wearing seat belts or wearing back packs. If the plate becomes problematic, the hardware can be removed once the bone has adequately healed. Hardware is usually left in place 8 months to a year depending on age. In the younger population (adolescents and younger), it is beneficial to remove the hardware at 8 months regardless. This is done to prevent bony overgrowth of the plate which makes hardware removal significantly harder later in life, if this were required.

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. Whether your treatment involves surgery or not, it can take several months for your collarbone to heal. It may take longer in diabetics or people who smoke or chew tobacco. Most people return to 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 your fracture fragments to move or your 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.