Clavicle Fractures

Fractures of the clavicle are common and account for about 5% of all adult fractures. They are especially frequent in children, adolescents, and young adults.  Most fractures occur in the middle of the bone.

Clavicle fractures typically occur from a direct impact to the shoulder area or a fall on an outstretched hand. Common causes include:

• Sports injuries: High-contact sports such as football, hockey, and rugby, or activities like cycling, skiing, and horseback riding, present a risk for clavicle fractures. Falls and collisions in these sports often result in direct trauma to the shoulder.
• Falls: A person may land directly on the shoulder or extend an arm to break the fall, which transmits force up the arm to the clavicle, causing it to break.
• Motor vehicle accidents: Car, motorcycle, or bicycle accidents often involve significant force to the body, leading to potential clavicle fractures.
• Birth injuries: In rare cases, clavicle fractures can occur during childbirth if there is difficulty delivering the baby’s shoulder.

Symptoms of a clavicle fracture can vary depending on the severity of the break but generally include:

• Intense pain: Sharp pain at the site of the fracture, which worsens with shoulder movement.
• Swelling and bruising: The area around the fracture site often becomes swollen, bruised, and tender to the touch.
• Deformity: In some cases, the broken ends of the clavicle may shift, creating a visible bump or tenting of the skin where the bone is pushing against it.
• Limited mobility: Difficulty in raising the arm or moving the shoulder due to pain and the disruption of normal bone alignment.
• Grinding sensation: A grating or grinding feeling can occur when attempting to move the arm.
• Nerve or blood vessel injury: Although rare, severe fractures can damage nearby nerves or blood vessels, potentially causing numbness, tingling, or coolness in the affected arm.

A clavicle fracture is diagnosed through a physical examination and imaging tests. Dr. Cinque will inquire about how you injured your clavicle, your symptoms and when they began.

During the physical exam, Dr. Cinque will inspect the shoulder for swelling, tenderness, and deformity. He will also assess the shoulder and arm range of motion and check for signs of nerve or blood vessel damage.

Dr. cinque will order X-rays to confirm a clavicle fracture and evaluate its severity. In complex cases, a CT scan may be necessary for a more detailed view of the fracture, especially if surgical planning is required.

Treatment for a clavicle fracture depends on several factors, including the location of the fracture, whether the bone fragments are displaced (out of alignment), and the patient’s age, overall health, and activity level.

Nonsurgical management

Most clavicle fractures, especially those where the bone fragments remain aligned or are only slightly displaced, can be managed without surgery. This includes:

• A sling or shoulder immobilizer is used to support the arm and hold the collarbone in place, reducing pain and preventing further injury while the bone heals. The sling is usually worn for several weeks, depending on the fracture’s severity.
• Over-the-counter pain relievers like acetaminophen or anti-inflammatory drugs (NSAIDs) can help alleviate pain and reduce swelling.
• Activity modification to avoid activities that stress the shoulder or risk additional injury, such as lifting heavy objects or engaging in sports, until the fracture heals.
• After the initial healing phase, a physical therapy program is typically recommended to restore shoulder strength, flexibility, and range of motion.

Surgical treatment

Surgery may be necessary if the fracture is significantly displaced, if there are multiple fracture fragments (comminuted fracture), or if the fracture has broken through the skin (open fracture). Surgery is also often considered for high-performance athletes or those with a high physical activity level to ensure a more precise alignment and faster recovery. Surgical management offers increased patient satisfaction and earlier return to physical activity. Surgical options include:

• Plate and screw fixation: This is the most common surgical technique for clavicle fractures. The surgeon realigns the bone fragments and secures them with a metal plate and screws along the bone.
• Intramedullary fixation: In this an open reduction with internal fixation procedure, a metal rod is inserted into the bone to hold the fragments in place. This technique may result in a smaller incision and less soft tissue disruption than plate fixation.