FAQS on Clavicle Fracture
Clavicle fracture comprises of about 5-10% of all fractures reported in the below-25 age group. The apparent position of the bone and intensity of force it is subject to make your collarbone’s thin midshaft a likely site of injury. Though minimum non-operative treatment, collar-and-cuff slings, and analgesia medication suffice for the healing of collarbone fracture, it may require internal fixation or invasive procedures in serious instances.
What is clavicle fracture?
Clavicle fracture simply means a broken collarbone. The clavicle or collarbone stretching to both sides of the upper chest connects the shoulder with the breastbone. It is most susceptible to fracture in people under 25 years or those above 55 years of age. Women older than 75 years are also found to be at increased risk of the injury. While a direct blow to the bone due to fall or accident is the most common cause of clavicle fracture, calcium deficiency also plays a role in making it fragile.
How does clavicle fracture occur?
The collarbone extends on both sides of human chest. One end is attached to the upper part of the breastbone while the other is connected to the sternum or breastbone. This is a long bone located directly under the skin and can be seen easily, as it is without much tissue coverage or any overlying protection.
The location makes the collarbone subject to intense force when one falls directly onto the shoulder. Even in an outstretched arm position, the fall leads to transmission of the force to the bone. Such conditions make the collarbone prone to breakage, which is known as clavicle fracture.
The thin middle portion of the collarbone is the most injured part and midshaft fractures contribute to almost three-fourth of all clavicle fractures. Lateral fractures impacting the distal portion come second with 15 to 20 percent while fractures in proximal portion are rare.
What are the symptoms of clavicle fracture? When to see a doctor?
- Pain in the collarbone making arm movements a problem
- Dull to extreme clavicle ache
- Shoulder slumping downward and foreward
- Upper extremity movement pain
- Bump at the place of clavicle fracture
- Collarbone bruising and swelling
- Grinding sensation when the arm is raised
- Fracture may be felt due to thin skin cover
- Pain radiating to surrounding muscles
- Shoulder stiffness
What causes clavicle fracture?
- Falling on the shoulder
- Direct blow to the shoulder caused in an accident or activity
- An outstretched arm fall
- Clavicle fracture in babies passing through the birth canal
- Low calcium and Vitamin D intake
- Sports injuries caused by collisions or extreme sport participations
- Vehicle accidents
What are the risk factors?
Calcium and Vitamin D deficiencies in the diet make bones weak and put the already fragile collarbone at high risk of fracture. Extreme sports events make players prone to collisions and shoulder accidents that enhance the risk of clavicle fracture. Those leading sedentary lives also face the threat as clavicle muscle stabilizers become weak in the absence of exercises.
How is clavicle fracture diagnosed?
X-Ray of the clavicle is the most common way to diagnose the clavicle fracture. Doctors inquire about the nature of injury received and examine any deformity, including fracture-site bump. CT scan or MRI may be suggested if there is the possibility of injury to associated muscles, joints, or bones.
What are the treatment methods available for clavicle fracture?
- Nonsurgical Treatment
The treatment option is the best for most of the cases where the broken parts remain at their place in the right line.
- Arm Support: Collar-and-cuff arm sling is wrapped around the arm to provide comfort and rest to the broken collarbone. Kept in a “figure-of-eight” position, it keeps the arm immobile while allowing the clavicle fracture to heal without any further stress.
- Medication: Doctors prescribe pain medication, including acetaminophen, which brings freedom from painful sensations as the collarbone heals.
- Physical Therapy: Shoulder and elbow movements help the muscles gain strength and beat stiffness caused by immobility of arm during the healing. However, it must be started after the fracture is healed and under proper guidance.
- Rest and Ice Therapy: Apply ice to the injured collarbone part and give ample rest from stress and strain to heal faster.
- Surgical Treatment
Surgery is the option when broken bones move out of their right position requiring intervention to keep the alignment intact. Most surgical procedures involve repositioning of bones and keeping them aligned using plates and screws. Once the healing is complete and bones grow aligned perfectly, these plates and screws are removed in a minor surgical procedure.
- Anesthetic Injections
Anesthetic medications are injected to the injured area to keep the pain suppressed for weeks at a time while the healing takes place.
What are the likely outcomes and chances of clavicle fracture recovery? How long will the clavicle fracture take to heal?
Clavicle fracture heals completely. However, the time it takes varies depending on age, medical condition, complications, and fracture location. Adults use the sling for 3 to six weeks for the initial healing of the bone and soft tissues while children needs less than 2 weeks for the same. The severity of fracture decides commencement and gradual increase in the intensity of physical activities and workouts after the sling is removed.
Complete healing in adults may take 10-12 weeks while children require about 5 weeks. Researches show that clavicle fractures, when not fragmented into more pieces, heal completely within 4 months. Surgery may require several more months of rehabilitation and the plates and screws usually remain for 6 to 12 months. Healing may become slow in diabetics.
A bump develops at the place of clavicle fracture. Though it dilutes with healing, a small permanent bum is likely to remain there. Once the fracture heals, you can carry your usual activities as before.
What are complications associated with clavicle fracture?
Unless treated effectively, clavicle fracture may lead to
- Injury to nerves and blood vessels
- Numbness in the arm
- Poor alignment of bones
- AC joint weakness
- Bony lump at the place of fracture
- Infections in the bone
- Osteoarthritis of the joints
Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR: Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. Instructional Course Lectures, Vol. 59. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010, p 215.Zlowodzki M, Zelle BA, Cole PA, et al; Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005 Aug;19(7):504-7.
Lenza M, Buchbinder R, Johnston RV, Belloti JC, Faloppa F. Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009363. DOI: 10.1002/14651858.CD009363.pub2.
Jubel A, Andermahr J, Prokop A, et al; Treatment of mid-clavicular fractures in adults. Early results after rucksack bandage or elastic stable intramedullary nailing. Unfallchirurg. 2005 Sep;108(9):707-14.
Craig E: Fractures of the shoulder, in Rockwood C, Matsen F (eds): The Shoulder, ed 2. Philadelphia: W.B. Saunders Co., pp 428-553.
Post M: Current Concepts in the Treatment of Fractures of the Clavicle. Clinical Orthopaedics and Related Research 1989; 245: 89-101.
MATTHEW PECCI, MD, and JEFFREY B. KREHER, MD, Boston University, Boston, Massachusetts, Clavicle Fractures. American Family Physician. 2008 Jan 1;77(1):65-70.
Clavicular fractures in adults. In: DeLee J, Drez D, eds. DeLee and Drez’s Orthopaedic Sports Medicine: Principles and Practice. 2nd ed. Philadelphia, Pa: Saunders; 2003:958-68.
Kim W, McKee MD. Management of acute clavicle fractures. Orthop Clin North Am. Oct 2008;39(4):491-505, vii.
Chalidis B, Sachinis N, Samoladas E, Dimitriou C, Christodoulou A, Pournaras J. Acute management of clavicle fractures. A long term functional outcome study. Acta Orthop Belg. Jun 2008;74(3):303-7.