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Clavicle Fractures

The clavicle / collarbone, is the bone connecting your sternum to the scapula (shoulder blade).  The clavicle helps to support the upper extremity.

Clavicle fractures are a common injury, accounting for between 2 and 5% of all fractures, and are usually the result of a fall or direct impact onto the shoulder. Clavicle fractures are separated based on location of the fracture within the bone with the clavicle being divided into thirds. Location of the fracture is one aspect that helps guide treatment as distal third fractures have inherently poorer healing potential based on blood supply.

Mid-shaft (middle third): Approximately 75% of clavicle fractures.

Distal-third: Approximately 30% of clavicle fractures.

Medial-third: Approximately 5% of clavicle fracture.

Patients with a clavicle fracture complain of shoulder pain and may have swelling, bruising and visible deformity of the clavicle.  Swelling and bruising may track into the anterior chest as well as the arm. 

Physical examination as well as x-ray imaging are usually all that is required to determine a clavicle fracture and make recommendations for treatment options. The goals for treatment of a clavicle fracture is to obtain bone healing with minimal deformity and no shoulder functional loss.  A physician specializing in shoulder and orthopedic trauma will be able to assess whether nonoperative or operative treatment would be best to minimize pain as well as restore optimal shoulder function.   

If nonoperative treatment is advised, treatment consists of sling immobilization as casts and splints are not feasible.  Sling immobilization will usually allow healing.  Pain medication is usually needed initially as well.

Several factors play a role in making a decision about a need for surgery:

  1. The degree of displacement.  If there is substantial displacement (usually vertical), then operative treatment is usually needed as bones need to be in close proximal to heal.
  2. The degree of shortening. If there is significant shortening, surgery is usually advised as shortening of the clavicle can lead to shoulder pain and weakness.
  3. The degree of comminution (how many pieces). In general, the more pieces or fragments of bone there are the better to surgical fix to realign the pieces to allow healing.

These factors as well as the age of the patient, arm dominance and any co-morbidities (diabetic, smoking) play a factor in allowing your physician to guide your treatment. 

Most clavicle fractures heal within 6–12 weeks in adults, and 3–6 weeks in children.  The pain usually improves within a few weeks.

Recovery is usually complete and a full return to activity can be expected. Patients may notice a persistent bump (or have a scar) where the fracture was but usually this is not painful or does not limit activity.

William Schell, MD

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