Clavicle

Your clavicle (collarbone) is a part of your skeletal system that connects your arm to
your body. Ligaments connect this long, thin bone to your sternum and shoulder. Your
clavicle is prone to injuries like a clavicle fracture, dislocated shoulder and separated
shoulder. Falls are a top cause of clavicle injuries.

Where is the clavicle?

The clavicle is the bone that connects the breastplate (sternum) to the shoulder. It is a
very solid bone that has a slight S-shape and can be easily seen in many people. It
connects to the sternum at a joint with cartilage called the sternoclavicular joint. At the
other end, the bone meets the shoulder area at a part of the shoulder blade (scapula)
called the acromion. The joint at that end of the bone containing cartilage is called the
acromioclavicular joint.

The collarbone acts as a strut to connect the sternum to the shoulder blade. Because of
the critical location of the clavicle, any severe force on the shoulder, such as falling
directly onto the shoulder or falling on an outstretched arm, transfers force to the
clavicle. As a result, the collarbone is one of the most commonly broken bones in the
body.

How do you know if you have a clavicle fracture?

When bones break, there is swelling due to bleeding from the blood vessels in and
around the bone. There is also pain from the broken bone due to damage of
microscopic nerve endings around the bone. Sometimes the bone is broken enough to
create an angle between the broken ends, which causes a deformity along the bone.
Usually with a broken collarbone the pain and swelling are severe and there may be a
visible deformity. Often there is pain at the site of the fracture with any attempt to move
the arm. The only way to verify if there is a fracture is to get an X-ray of the area.

What is the treatment for a clavicle fracture?

The first thing the physician will do is take an X-ray to determine if the clavicle is broken,
where the fracture is located and how many pieces it is broken into. Clavicle fractures
are basically divided into three types based upon location. Fractures near the sternum
are the least common (less than 5 percent of all clavicle fractures). Fractures near the
AC joint are the second most common and can come in many different patterns. The
most common fractures of the clavicle are in the middle of the shaft of the bone,
approximately halfway between the sternum and the AC joint.

The most common way to treat the fractures in the middle is with immobilization with
either a sling or a special bandage called a figure-of-8 splint. Studies have shown that
these fractures heal just as quickly and as well with a sling as with the figure-of-8 splint,
so we recommend a sling in a majority of cases. The figure-of-8 splint is generally
uncomfortable, difficult to wear nonstop for six or eight weeks and can result in skin
problems and a smelly patient because it should not be removed to wash the armpit.
Figure-of-8 splints are not indicated or useful in fractures of the clavicle near the AC
joint. However, some orthopaedical doctors have strong opinions about the use of this
figure-of-8 device, and it can produce an acceptable result.

The second thing that helps in the treatment of clavicle fractures is pain relief with cold
therapy and pain medication. It is recommended that you ice the fractured area for 15 to
20 minutes every two hours for as long as necessary to decrease the pain and swelling.
Heat is not recommended. Pain medication in the form of narcotics is the best for relief
of pain from a fractured clavicle, and you may need it for several weeks, especially to
help you sleep. Many patients with this injury have to sleep sitting up to be comfortable.
Other pain-relieving medications such as acetaminophen or nonsteroidal medications
may be used, but they generally will not be adequate by themselves until the pain and
swelling start to subside.

How long does a clavicle fracture take to heal?

How long it takes the fracture to heal depends upon many factors, such as age, the
location of the fracture and how many pieces it is broken into. Clavicle fractures in
children (younger than 8 years old) may heal in four or five weeks, and clavicle
fractures in adolescents may take six to eight weeks. However, fractures in adults
or teenagers who have stopped growing take 10 to 12 weeks to heal and may take
longer. Most clavicle fractures will heal completely by four months in an adult.
There are some indications that clavicle fractures broken into more pieces take
longer than ones with a fewer fragment.
Treatment
Nonsurgical Treatment
If the broken ends of the bones have not significantly shifted out of
place, you may not need surgery. Many broken collarbones can heal
without surgery.

Nonsurgical treatment may include:

 Arm support. A simple arm sling is usually used for comfort

immediately after the break and to keep your arm and shoulder in
position while the injury heals.
 Medication. Pain medication, including acetaminophen, can help
relieve pain as the fracture heals.
 Physical therapy. Although there will be some pain, it is important
to maintain arm motion to prevent shoulder and elbow stiffness.
Often, patients will begin doing exercises for elbow motion
immediately after the injury.

After a clavicle fracture, it is common to lose some shoulder and

arm strength. Once the bone begins to heal, your pain will decrease
and your doctor may start gentle shoulder exercises. These
exercises will help prevent stiffness and weakness. You will start
more strenuous exercises gradually once the fracture is completely
healed.
Follow-up care. You will need to see your doctor regularly until your
fracture heals. During these visits, the doctor will take X-rays to make
sure the bone is healing in a good position. After the bone has healed,
you will be able to gradually return to your normal activities.
Complications. In some cases, a clavicle fracture can move out of place
before it heals. It is important to follow up with your doctor as scheduled
to make sure the bone stays in position.
If the fracture does not heal, it is called a nonunion.
 In some cases of nonunion, the patient has very little pain and good
motion, so no further treatment is required.
 In other cases, nonunion can result in significant pain and may
require an operation for repair.
If the fracture fragments do move out of place and the bones heal in that
position, it is called a malunion. Surgical treatment for this is very rare,
determined by how far out of place the bones are and how much this
affects your arm movement.

A large bump over the fracture site may develop as the fracture heals.
This usually gets smaller over time, but a small bump often remains
permanently.
Surgical Treatment
If the broken ends of the bones have significantly shifted out of place,
your doctor may recommend surgery.

Surgery typically involves putting the broken pieces of bone back into
position and preventing them from moving out of place until they are
healed. This can improve shoulder strength when you have recovered.

Open reduction and internal fixation. This is the procedure most often
used to treat clavicle fractures. During the procedure, the bone
fragments are first repositioned (reduced) into their normal alignment.
The pieces of bone are then held in place with special metal hardware.

Common methods of internal fixation include:

 Plates and screws. After being repositioned into their normal

alignment, the bone fragments are held in place with special screws
and metal plates attached to the outer surface of the bone.

After surgery, you may notice a small patch of numb skin below the
incision. This numbness will become less noticeable with time.
Because the clavicle lies directly under the skin, you may be able to
feel the plate through your skin.

Plates and screws are not routinely removed after the bone has
healed, unless they are causing discomfort. Problems with the
hardware are not common, but some patients find that seatbelts and
backpacks can irritate the collarbone area. If this happens, the
hardware can be removed after the fracture has healed.

Pain management. After surgery, you will feel some pain. This is a
natural part of the healing process. Many patients find that using ice and
non-prescription pain medications are sufficient to relieve pain.

If your pain is severe, your doctor may suggest a prescription-strength

medication, such as an opioid, for a few days.

Be aware that although opioids help relieve pain after surgery, they are a
narcotic and can be addictive. Opioid dependency and overdose have
become critical public health issues. For this reason, opioids are typically
prescribed for a short period of time. It is important to use opioids only
as directed by your doctor and to stop taking them as soon as your pain
begins to improve.
Rehabilitation. Specific exercises will help restore movement and
strengthen your shoulder. Your doctor may provide you with a home
therapy plan or suggest that you work with a physical therapist.

Therapy programs typically start with gentle motion exercises. Your

doctor will gradually add strengthening exercises to your program as
your fracture heals.

Although it is a slow process, following your physical therapy plan is an

important factor in returning to all the activities you enjoy.

Complications. There are risks associated with any type of surgery.

These include:

 Infection
 Bleeding
 Problems with wound healing
 Pain
 Blood clots
 Damage to blood vessels or nerves
 Reaction to anesthesia
Risks that are specific to surgery for clavicle fractures include:
 Difficulty with bone healing
 Lung injury
 Numbness below the clavicle
 Hardware irritation
Patients who smoke or use tobacco products, have diabetes, or are
elderly are at a higher risk for complications both during and after
surgery. They are also more likely to have problems with wound and
bone healing.

Outcome
Whether or not your treatment involves surgery, it can take several
months for your collarbone to heal. Healing may take longer in diabetics
or in people who smoke or use tobacco products.

Most people return to their regular activities within 3 months of their

injury. Your doctor will tell you when your injury is stable enough to do
so. Returning to regular activities or lifting with your arm before your
doctor advises may cause the fracture fragments to move or the
hardware to break. This may require you to start your treatment from the
beginning.

Once your fracture has completely healed, you can safely return to sports
activities.