Clavicle Fracture (Broken Collarbone)

Clavicle Fracture (Broken Collarbone)

A broken collarbone is also known as a clavicle fracture. This is a very common fracture that occurs in people of all ages.

Anatomy

The collarbone (clavicle) is located between the rib cage (sternum) and the shoulder blade (scapula), and it connects the arm to the body.

The clavicle lies above several important nerves and blood vessels. However, these vital structures are rarely injured when the clavicle breaks, even though the bone ends can shift when they are fractured.

Description

The clavicle is a long bone and most breaks occur in the middle of it. Occasionally, the bone will break where it attaches at the rib cage or shoulder blade.

Cause

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

Symptoms

Clavicle fractures can be very painful and may make it hard to move your 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

Non-Surgical Treatment

If the broken ends of the bones have not shifted out of place and line up correctly, you may not need surgery. Broken collarbones can heal without surgery.

Arm Support

A simple arm sling or figure-of-eight wrap is usually used for comfort immediately after the break. These are worn to support your arm and help keep it in position while it heals.

Medication

Pain medication, including acetaminophen, can help relieve pain as the fracture heals.

Physical Therapy

While you are wearing the sling, you will likely lose muscle strength in your shoulder. Once your bone begins to heal, the pain will decrease and your doctor may start gentle shoulder and elbow exercises. These exercises will help prevent stiffness and weakness. More strenuous exercises can gradually be started once the fracture is completely healed.

Doctor Follow-Up

You will need to see your doctor regularly until your fracture heals. He or she will examine you and take x-rays to make sure the bone is healing in good position. After the bone has healed, you will be able to gradually return to your normal activities

Complications

The 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 fragments do move out of place and the bones heal in that position, it is called a "malunion." Treatment for this is 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 may remain permanently.

Surgical Treatment

If your bones are out of place (displaced), your doctor may recommend surgery. Surgery can align the bones exactly and hold them in good position while they heal. This can improve shoulder strength when you have recovered.

Plates and Screws

During this operation, the bone fragments are first re-positioned into their normal alignment, and then held in place with special screws and/or by attaching metal plates 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 there is not a lot of fat over the collarbone, you may be able to feel the plate through your skin.

Plates and screws are usually not removed after the bone has healed, unless they are causing discomfort. Problems with the hardware are not common, but sometimes, seat belts and backpacks can irritate the collarbone area. If this happens, the hardware can be removed after the fracture has healed.

Pins

Pins are also used to hold the fracture in good position after the bone ends have been put back in place. The incisions for pin placement are usually smaller than those used for plates. Pins often irritate the skin where they have been inserted and are usually removed once the fracture has healed.

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.

Surgical Complications

People who use any kind of tobacco product, have diabetes, or are elderly are at a higher risk for complications during and after surgery. They are also more likely to have problems with wound and bone healing. Be sure to talk with your doctor about the risks and benefits of surgery for your clavicle fracture.

There are risks associated with any surgery, including:

• Infection
• Bleeding
• Pain
• Blood clots in your leg
• Damage to blood vessels or nerves
• Nausea

The risks specific to surgery for collarbone fractures include:

• Difficulty with bone healing
• Lung injury
• Hardware irritation

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