Clavicle Fractures

The clavicle is a bone in the shoulder girdle that plays an important role in normal shoulder biomechanics. It is a strut from the anterior chest wall ( sternum ) to the acromion, which is an extension from the shoulder blade or scapula. The scapula is suspended and held in position by ligaments from from another scapular projection called the coracoid.

Clavicle fractures (collarbone) are relatively common fractures in the upper extremity and can occur in all ages, including infants as they exit the birth canal. Most clavicle fractures occur with a fall directly onto the shoulder or a fall onto an outstretched arm. The clavicle can also break from a direct blow in sports and trauma from a motor vehicle accident. A broken collarbone can be very painful and can make it hard to move your arm. Symptoms include swelling and increased pain when moving the shoulder.

X-ray image of a displaced and comminuted ( mulitple pieces ) mid-shaft left clavicle fracture

A clavicle fracture can be very painful and may make it hard to move your shoulder and arm. Other symptoms and signs 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

Nonsurgical Treatment

If the fracture is well aligned and not significantly angled or displaced, it can often be successfully treated conservatively. Nonsurgical treatment may include:

  • Sling: An arm sling is helpful to support the upper extremity, which will help reducing pain.
  • Medications: Pain medications, including tylenol, can help relieve pain as the fracture heals.
  • Physical Therapy: Therapy for shoulder motion is not started until there has been some healing of the fracture. However, rehabilitation focusing on motion in the elbow, wrist, and hand are often started immediately after the injury.
X-ray image of a clavicle fracture that was treated with an open reduction and internal fixation using compression screws and a locking superior clavicle plate

Surgical Treatment

If there is gapping, displacement, and shortening of the fracture, all of which can contribute to poor outcomes, surgery can be considered. The surgery typically involves an open reduction and internal fixation of the fracture. 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. Surgical fixation results in a faster recovery, quicker time back to sports activities, and a higher chance that the fracture successfully heals.

Watch surgical videos of open reduction and internal fixation of clavicle fractures