Clavicle Fractures

What is Clavicle Fractures?

Breaking your collarbone, or clavicle, is quite common, making up about 10% of all bone breaks. In fact, it’s the most common type of fracture in children. A collarbone fracture is most often caused by a fall onto the side of the shoulder. X-rays are used to confirm the break and help decide how to treat it. Usually, collarbone fractures can be treated without surgery. However, if the bone is severely out of place or shattered, surgery may be needed to fix it.

What Causes Clavicle Fractures?

In about 87% of cases, a broken collarbone (or clavicle fracture) happens because of falling directly onto the side of the shoulder. Other less common causes of these fractures include direct injury to the collarbone or falling onto an outstretched hand.

Risk Factors and Frequency for Clavicle Fractures

Clavicle fractures, or broken collarbones, make up 2% to 10% of all bone breaks. These types of fractures are common, affecting 1 in 1000 people each year, and they’re the most often seen in children. It’s also interesting to note that about two-thirds of all clavicle fractures happen in males. These fractures are most commonly seen in two distinct age groups – men under 25 years old, often due to sports-related injuries, and patients over 55, generally due to falls. In the age group 13-20, nearly 20 percent of females and over a third of males experience a clavicle fracture at some point.

When we look at which part of the clavicle is most often affected, we find that:

The middle part of the clavicle is fractured in 69% of cases,
The far end of the clavicle is fractured in 28% of cases,
The part of the clavicle closest to the center of the body is fractured in 3% of cases.

In children, 95% of all clavicle fractures happen in the middle part of the bone. For children under 10, these fractures often stay aligned correctly, but in children over 10, the bone pieces are commonly displaced, or moved out of place. Clavicle fractures are also very common during childbirth, making up 95% of all fractures seen at that time.

Signs and Symptoms of Clavicle Fractures

Clavicle fractures refer to a break in the collarbone. Patients with such fractures usually experience pain at the fracture site and tend to keep the injured arm closer to their body. Some people might even hear a snapping or cracking sound at the time of the injury. The most common cause includes falling directly onto the shoulder, but a direct hit to the collarbone or a fall onto an outstretched hand could also lead to such fractures.

When a doctor examines the patient, they may observe a deformation over the fracture site. The shoulder of the patient might appear lower, especially if the middle third of the clavicle is fractured, as the muscles pull the broken bone fragment downward. By contrast, the upper muscle displaces the top bone fragment upward. Other signs include tenderness, a grating sound or feeling when the area is touched, discoloration or swelling around the clavicle. In severe cases, the break can lead to the skin above it bulging out, which signals a high risk of the fracture becoming an open one.

Given the close location of the clavicle to major vessels and nerves, patients should undergo a detailed neurovascular examination. Issues could include weakened pulses further down the arm, discoloration or swelling, suggesting a vessel injury. Meanwhile, nerve damage could lead to problems with feeling or movement in the arm. A full lung examination is also necessary, as, in rare cases, there could be an associated injury to the top of the lung causing a pneumothorax or hemothorax. Signs of this could include shortness of breath or weaker breathing sounds. The doctor should also check the surrounding ribs and shoulder blade for potential additional fractures.

Stress fractures can also occur on the collarbone due to repetitive strain from various activities, even if the patient hasn’t experienced any distinct trauma.

Testing for Clavicle Fractures

If you’ve hurt your collarbone or “clavicle,” your doctor will want to take an X-ray of it from the front. They may also use an angled X-ray, tilted about 45 degrees, to get a better look at any possible misalignment of the collarbone. This secondary view can also help mitigate the overlapping image of the first rib and shoulder blade, which could potentially obscure the view of a fractured collarbone.

While most collarbone fractures can be spotted with these two X-rays, some hard-to-see fractures near the ends of the collarbone may require a CT scan for better insight and guidance in treating the injury. Furthermore, if your doctor is worried about additional injuries such as a punctured lung or rib injury, they might order a specific type of chest X-ray where you let out your breath.

If the doctor is concerned that blood vessels or nerves may be injured, they might need to do more in-depth imaging tests like an arteriogram, an ultrasound, or a CT scan. These tools can guide them on what to do next.

If your doctor suspects a stress fracture towards the base of the collarbone, they would again start with an X-ray and potentially a CT scan if needed. If the area around the fracture is swollen and the X-ray and CT scan results aren’t clear, they might order further imaging tests. This could be to rule out inflammation or a tumor.

Treatment Options for Clavicle Fractures

When a patient experiences breaking or cracking of their collarbone (clavicle), doctors may recommend an immediate consultation with a bone specialist (orthopedic doctor) in certain circumstances. These include situations when the break has caused damage to blood vessels or nerves, the bone has broken the skin, the bone is severely twisted or bent, or there’s any cut on the skin near the broken bone. These are strong signs indicating the need for surgery.

Other less urgent scenarios that might still warrant surgery include certain types of fractures located in the lower third of the clavicle, shortening of the broken bone by more than 1.5 cm or 15% compared to that of the other side, shoulder injuries involving multiple bones, serious issues with seizures or muscle movement, and cosmetic concerns arising from bone displacement.

After a thorough evaluation for any related injuries and confirming the need for a surgical intervention, the primary treatment for a broken clavicle is pain relief, immobilizing the area, and regular follow-ups with the orthopedic doctor.

For more common types of clavicle fractures that occur in the middle part of the bone, non-surgical treatment is commonly used. This involves either providing support with a sling or a more involved method of using a figure-of-eight brace to bind the shoulders back, thus reducing the fracture. Studies show that these treatments are similarly effective. In the case of simple fractures where the bone pieces aren’t significantly displaced, using these non-surgical methods can lead to faster recovery and fewer complications compared to surgery. However, for patients at high risk of their broken bone not healing properly due to severe displacement, shortening, or fragmentation, surgical procedures often yield better outcomes.

If the break is located in the distal part of the clavicle, closer to the shoulder, patients are typically given a simple sling for immobilization. A figure-of-eight brace is not recommended as it could worsen the position of the broken bone. Because these types of fractures have a high risk (about 30%) of failing to heal properly, a referral to an orthopedic specialist is beneficial. There’s an ongoing debate about the best treatment approach for these fractures. Some studies suggest surgery can lead to better recovery, while others find conservative, non-surgical management to be just as effective.

If the fracture is located in the proximal part of the clavicle, toward the neck, and is not significantly displaced, it’s typically treated with conservative approaches. A sling is given for support and comfort, and the use of pain relief medications and early movement of the shoulder joint are advised. Significantly displaced proximal clavicle fractures are rare due to strong supportive ligaments in that area. However, nearly 90% of these types of displaced fractures are associated with serious related injuries. If there is any sign of damage to arteries or nerves, these fractures should be immediately corrected, and a thorough examination for potential severe chest injuries should be performed.

Children with a broken clavicle are treated similarly to adults. However, their significantly stronger ability to regenerate bone covering (periosteum) enables faster healing than in adults. Bone healing can often form a kind of lump (callus) under the skin in children, which parents should be aware is a normal part of the healing process.

When diagnosing a broken collarbone (or clavicle fracture), doctors may also consider similar conditions such as:

Injury to the acromioclavicular joint (where the collarbone meets the shoulder blade)
Rib fracture
Scapular fracture (a break in the shoulder blade)
Shoulder dislocation (when the arm bone pops out of the shoulder socket)
Rotator cuff injury (damage to the group of muscles and tendons that surround the shoulder joint)
Sternoclavicular joint injury (injury to the joint where the collarbone meets the sternum or breastbone)

Doctors must also consider potential complications of a broken collarbone, like:

Pneumothorax (collapsed lung)
Brachial plexus injury (damage to the network of nerves that sends signals from your spinal cord to your shoulder, arm, and hand)
Subclavian vessel injury (damage to the major arteries and veins located beneath the collarbone)

In some cases, collarbone pain could be the result of inflammation or a tumor, which can mimic a stress fracture.

What to expect with Clavicle Fractures

Most people who fracture their clavicle, or collarbone, recover well. Often, these fractures don’t need surgery and are treated by immobilizing the arm with a sling or a figure-of-eight brace. This method allows the bone to heal naturally, which usually takes between 6 to 12 weeks for adults, and 3 to 6 weeks for children.

Once the bone is stable, physical therapy can commence to help regain movement and re-strengthen the area. Patients can generally return to their daily activities around 6 weeks after the injury. However, getting back to full strength, especially for athletes in contact sports, might need 2 to 4 months of rehabilitation. This involves showing proof of the bone healing on an X-ray, no pain when touched, full range of movement, and normal strength in the shoulder.

Possible Complications When Diagnosed with Clavicle Fractures

When it comes to clavicle (collarbone) fractures, serious complications are unusual. However, injury to the network of nerves in the shoulder (the brachial plexus) or the subclavian vessels (large blood vessels in the upper chest) can happen either when the fracture is first presented or while the bone is healing. Formation of abnormal tissue (an excessive callus) during healing can press on the brachial plexus and result in peripheral neuropathy, a condition causing weakness, numbness and pain in your hands and arms.

The most frequent complication related to clavicle fractures is malunion, which means that the bone heals incorrectly, leading to changes in shape, shorter length, or poor cosmetic appearance. Despite the deformity, most patients with clavicle malunions usually retain full functionality and do not experience significant problems. However, some malunions can cause problems affecting the nerves or functioning of the affected area, especially if shortening of the bone is greater than 2 cm. In cases where patients have ongoing pain, limited range of motion, or reduced strength as a result of the malunion, surgery might be recommended.

Nonunion is a term used when a fracture fails to heal within 4 to 6 months. Nonunion rates can escalate in certain conditions as well as depending on the location of the fracture in the clavicle. Surgical management may be required for patients with nonunion of the clavicle bone associated with ongoing pain, loss of range of motion, or loss of function.

Notably, complications at the end parts of clavicle bone fractures include nonunion, traumatic arthritis, or having severe injuries within the chest cavity. Degenerative arthritis within the shoulder joint may be a late complex that may occur in some patients.

Below are the associated complications according to various fracture locations on the clavicle:

Injury to the brachial plexus/subclavian vessels
Peripheral neuropathy due to excessive callus formation
Malunion of the fracture, potentially causing neural or functional issues
Nonunion of the fracture after 4-6 months
Further complications in specific sections of the clavicle
Degenerative arthritis within the shoulder joint as a late complication

Frequently asked questions

Clavicle fractures, also known as collarbone fractures, are quite common and make up about 10% of all bone breaks. They are most often caused by a fall onto the side of the shoulder. X-rays are used to confirm the break and determine the appropriate treatment, which usually does not require surgery unless the bone is severely out of place or shattered.

Clavicle fractures are common, affecting 1 in 1000 people each year.

Signs and symptoms of Clavicle Fractures include: - Pain at the fracture site - Keeping the injured arm closer to the body - Snapping or cracking sound at the time of the injury - Deformation over the fracture site - Lowered shoulder, especially if the middle third of the clavicle is fractured - Tenderness - Grating sound or feeling when the area is touched - Discoloration or swelling around the clavicle - Bulging of the skin above the fracture site in severe cases - Weakened pulses further down the arm, suggesting a vessel injury - Discoloration or swelling, suggesting a vessel injury - Problems with feeling or movement in the arm, indicating nerve damage - Shortness of breath or weaker breathing sounds, indicating an associated lung injury - Potential additional fractures in the surrounding ribs and shoulder blade It is important to note that stress fractures can also occur on the collarbone due to repetitive strain from various activities, even without distinct trauma.

Clavicle fractures can occur from falling directly onto the side of the shoulder, direct injury to the collarbone, or falling onto an outstretched hand.

The other conditions that a doctor needs to rule out when diagnosing Clavicle Fractures are: - Injury to the acromioclavicular joint (where the collarbone meets the shoulder blade) - Rib fracture - Scapular fracture (a break in the shoulder blade) - Shoulder dislocation (when the arm bone pops out of the shoulder socket) - Rotator cuff injury (damage to the group of muscles and tendons that surround the shoulder joint) - Sternoclavicular joint injury (injury to the joint where the collarbone meets the sternum or breastbone) - Pneumothorax (collapsed lung) - Brachial plexus injury (damage to the network of nerves that sends signals from your spinal cord to your shoulder, arm, and hand) - Subclavian vessel injury (damage to the major arteries and veins located beneath the collarbone) - Inflammation or a tumor, which can mimic a stress fracture.

The types of tests that may be needed for clavicle fractures include: - X-rays: An X-ray from the front and an angled X-ray tilted about 45 degrees can help diagnose most collarbone fractures. These X-rays can also help determine if there is any misalignment or overlapping of bones that may obscure the view of a fractured collarbone. - CT scan: If the X-rays are not clear or if there are hard-to-see fractures near the ends of the collarbone, a CT scan may be ordered for better insight and guidance in treating the injury. - Chest X-ray: If there is concern about additional injuries such as a punctured lung or rib injury, a specific type of chest X-ray where the patient lets out their breath may be ordered. - Arteriogram, ultrasound, or CT scan: If there is concern about blood vessel or nerve injuries, more in-depth imaging tests like an arteriogram, ultrasound, or CT scan may be needed. - Further imaging tests: If there is suspicion of a stress fracture towards the base of the collarbone or if the area around the fracture is swollen and the X-ray and CT scan results are not clear, further imaging tests may be ordered to rule out inflammation or a tumor.

Clavicle fractures can be treated through both surgical and non-surgical methods, depending on the severity and location of the fracture. For more common fractures in the middle part of the bone, non-surgical treatment is commonly used, which involves providing support with a sling or a figure-of-eight brace to bind the shoulders back. This non-surgical approach is effective for fractures where the bone pieces are not significantly displaced. However, for fractures with severe displacement, shortening, or fragmentation, surgical procedures often yield better outcomes. Distal clavicle fractures closer to the shoulder are typically treated with a simple sling, while proximal clavicle fractures toward the neck are usually treated conservatively with a sling, pain relief medications, and early movement of the shoulder joint. Children with clavicle fractures have a stronger ability to regenerate bone, which enables faster healing.

The side effects when treating Clavicle Fractures include: - Injury to the brachial plexus/subclavian vessels - Peripheral neuropathy due to excessive callus formation - Malunion of the fracture, potentially causing neural or functional issues - Nonunion of the fracture after 4-6 months - Further complications in specific sections of the clavicle - Degenerative arthritis within the shoulder joint as a late complication

Most people who fracture their clavicle recover well without surgery. The bone usually takes between 6 to 12 weeks to heal for adults and 3 to 6 weeks for children. Once the bone is stable, physical therapy can help regain movement and strength. Patients can generally return to their daily activities around 6 weeks after the injury, but full recovery, especially for athletes in contact sports, may take 2 to 4 months of rehabilitation.

An orthopedic doctor or bone specialist.