Clavicle/Collarbone Fractures

Overview

The clavicle, or collarbone, is an essential bone that connects the upper limb to your body’s trunk. Fractures of the clavicle are common, especially in athletes and weekend warriors, accounting for up to 10% of all fractures. While a clavicle fracture can be debilitating, 97% heal without surgery. Let’s take a closer look at the causes and symptoms of clavicle fractures and the various treatment options available to help you get back to your active lifestyle.

Anatomy

The clavicle is a long, slightly curved bone that runs horizontally across the top of the chest, connecting the breastbone (sternum) to the shoulder blade (scapula). Your collarbone plays a crucial role in providing support and stability to the shoulder joint, allowing for a wide range of motion in the arm by acting as a strut, holding the scapula and shoulder joint away from the ribcage.

Your collarbone enables you to perform various actions, such as lifting, pushing, and throwing. The clavicle’s slight curvature also helps in the absorption and distribution of forces generated during these movements, preventing potential injuries. It also protects the underlying nerves, blood vessels, and respiratory system.

Types of Clavicle Fractures

Clavicle fractures occur when the bone is subjected to a force it cannot withstand, such as a direct blow or a fall onto an outstretched arm. These fractures are classified into three types, depending on their location along the bone:

• Type I: This type of clavicle fracture occurs in the middle third of the clavicle – the most common location for such fractures. Accounting for about 80% of all clavicle fractures, Type I fractures are typically caused by a direct blow to the shoulder or an indirect force, such as a fall on an outstretched arm. Treatment for Type I fractures usually involves conservative management, such as immobilization with a sling or figure-8 brace.
• Type II: Representing approximately 15% of clavicle fractures, these fractures occur in the outer third of the clavicle, near the acromioclavicular joint. These fractures are often caused by a fall on the shoulder or a direct impact. Treatment for Type II fractures depends on the specific subcategory and the degree of displacement, with some fractures requiring surgery to stabilize the fracture and promote optimal healing.
• Type III: The rarest of the three types, these fractures occur in the inner third of the clavicle, near the sternum, and make up around 5% of all clavicle fractures. These fractures can result from a direct blow to the chest, or a force transmitted through the shoulder. Type III fractures are often associated with more severe trauma and may be accompanied by injuries to the underlying structures. Treatment for Type III fractures can vary depending on the extent of displacement and associated injuries, with some cases requiring surgery to ensure proper healing and function.

Symptoms

Clavicle fractures can have a variety of symptoms, depending on the severity and location of the injury. The most common symptoms of a clavicle fracture include:

• Pain and tenderness at the site of the fracture.
• Swelling and bruising.
• A visible bump or deformity.
• Difficulty moving the affected arm and shoulder.
• A grinding or cracking sensation when moving the shoulder.
• In severe cases, the fractured bone may puncture the skin, leading to an open fracture.

Besides the common symptoms, patients may also experience:

• Numbness or tingling in the arm or fingers, which may indicate nerve involvement.
• Shortness of breath or chest pain, particularly if the fracture is close to the sternum or if a bone fragment has punctured a lung.
• Weakness in the affected arm, which could be due to muscle or nerve damage.
• Visible shortening of the affected clavicle compared to the other side, in cases of significant displacement.

Diagnosis

A clavicle fracture, or broken collarbone, is commonly diagnosed through physical examination and diagnostic imaging. Initially, your physician takes a thorough medical history and inspects the affected area for signs of fracture, such as swelling, bruising, or deformity. They will also check your range of motion, muscle strength, and sensation in the shoulder and arm.

To confirm the diagnosis and get more information about the fracture, X-rays are typically ordered as they provide a clear view of the bone, revealing the location and severity of the break. In certain situations, computed tomography (CT) scans may be used to get a more detailed view of the fracture and surrounding structures, especially in cases where the fracture is complex, displaced, or involves joint surfaces.

Once the fracture has been diagnosed and assessed, your doctor will develop an appropriate treatment plan, ranging from conservative management (such as immobilization with a sling or figure-8 brace) to surgical intervention for more severe fractures. The primary goal of treatment is to restore normal shoulder function and ensure optimal recovery.

Treatment (Overview)

Treatment for clavicle fractures depends on the type and severity of the injury and the patient’s age, activity level, and overall health. In general, treatment options can be divided into non-surgical and surgical categories.

Non-surgical Treatments

For less severe collarbone fractures, non-surgical treatments may be recommended, including:

• Immobilization: Using a sling or figure-8 brace to keep the arm and shoulder in place, allowing the bone to heal.
• Pain management: Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol), may be recommended to help manage pain and inflammation.
• Physical therapy: The initial focus will be on gentle range of motion exercises, such as pendulum exercises, shoulder flexion, and abduction, to maintain joint mobility and prevent stiffness. As the bone heals and the patient can tolerate weight-bearing activities, the therapist will introduce strengthening exercises targeting the rotator cuff, deltoids, and scapular stabilizers, including isometric contractions, resistance band exercises, and weight training. Stretching exercises will be recommended to maintain flexibility, prevent muscle tightness, and reduce the risk of future injuries.
• Cold therapy: Applying ice packs to the affected area can help reduce swelling and ease pain. Be sure to wrap the ice in a thin towel or cloth. Apply to the affected area for 15-20 minutes, with 1-2 hours between applications.

Surgical Procedures/Treatments

For severe clavicle fractures, surgery may be needed. There are two principal surgeries available to patients.

Open Reduction and Internal Fixation (ORIF): During this procedure, the surgeon makes an incision over the fractured area to expose the bone. The broken bone segments are then realigned and held in place using plates, screws, or pins. This method provides stability and allows for proper bone healing. The plates and screws usually remain in place permanently unless they cause discomfort or complications, in which case they can be removed in a separate procedure after the bone has healed.

Intramedullary Nailing: This technique involves inserting a metal rod (nail) into the bone marrow cavity of the clavicle, which runs along the length of the bone. The rod holds the fractured bone segments together, providing stability and promoting healing. The nail may be left in place permanently or removed after the bone has healed, depending on the patient’s circumstances and the surgeon’s preference.

Next Steps

If you are experiencing symptoms or suspect you may be suffering from a clavicle fracture, please call for an appointment with Dr. Peter Howard to have it checked.