Clavicle Fracture
En Español (Spanish Version)

Definition
A clavicle fracture is a break in the clavicle bone (also called the collarbone). It connects the sternum (breastplate) to the shoulder.

The clavicle can fracture in three different places:

  • Middle third—the middle portion of the clavicle, which is the most common site for a clavicle fracture
  • Distal third—the end of the clavicle connecting to the shoulder
  • Medial third—the end of the clavicle connecting to the sternum
Distal Third Clavicle Fracture

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Causes
A clavicle fracture is caused by trauma to the clavicle bone. The trauma is usually caused by:

  • Direct blow to the clavicle
  • Falling on an outstretched arm or on the point of the shoulder
  • Newborn babies can break a clavicle passing through the birth canal
Risk Factors
A risk factor is something that increases your chance of getting a disease, condition, or injury.

  • Advancing age, because of the increased risk of falling
  • Osteoporosis
  • Certain congenital bone conditions
  • Participating in contact sports
  • Violence
  • Large newborns have a higher risk of fracture during birth
Symptoms
Symptoms include:

  • Pain, often severe
  • Sagging shoulder, down and forward
  • Inability to lift the arm because of pain
  • A lump or visible deformity over the fracture site
  • Tenderness and swelling of the affected area
Diagnosis
The doctor will ask about your symptoms, physical activity, and how the injury occurred. The injured area will be examined.

Images may be taken of your bodily structures. This can be done with:

  • X-rays
  • Ultrasound
Treatment
Treatment will depend on the severity of the injury. Treatment may involve:

  • Putting the pieces of the bone back in position, which may sometimes require anesthesia and more rarely surgery
  • Keeping the pieces together while the bone heals itself
  • Newborns and most children do not usually need to have the pieces of the bone put back in position unless the broken ends are very far apart
Brace or Sling
Most clavicle fractures can be treated either with a figure-of-eight strap, which is wrapped around the body and the shoulders, or with the arm in a sling. These devices help hold the shoulder in place while the clavicle heals. The doctor may prescribe pain medication.

Surgery
Surgery may rarely be needed to set the bone. The doctor may insert pins or a plate and screws in the bone to hold it in place while it heals. You will still need to wear the sling or figure-of-eight strap while you heal.

Exercises
When your doctor decides you are ready, start shoulder range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises. Do not return to sports activity until your clavicle is fully healed.

Healing Time
  • A child may heal as quickly as 3-4 weeks.
  • An adolescent may take 6-8 weeks to heal.
  • An adult may require 8-10 weeks to heal.
  • A lump at the fracture site may persist for years.
Prevention
To help prevent clavicle fractures:

  • Do not put yourself at risk for trauma to the clavicle bone.
  • Eat a diet rich in calcium and vitamin D.
  • Build strong muscles to prevent falls and to stay active and agile.



RESOURCES:
American Academy of Orthopaedic Surgeons

American Orthopaedic Society for Sports Medicine

CANADIAN RESOURCES:
Canadian Orthopaedic Association

Canadian Orthopaedic Foundation

References:
Clavicle fracture. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated June 2009. Accessed July 21, 2009.

Levy AM, Fuerst M. Sports Injury Handbook. New York, NY: John Wiley & Sons, Inc; 1993.

Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007121.

Shoulder trauma. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00394. Accessed July 15, 2008.

Stegeman SA, de Jong M, Sier CF, et al. Displaced midshaft fractures of the clavicle: nonoperative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial. BMC Musculoskelet Disord. 2011 Aug 24;12:196.

Vander Have KL, Perdue AM, Caird MS, Farley FA. Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents. J Pediatr Orthop. 2010 Jun;30(4):307-312.

8/20/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Joshi N, Lira A, Mehta N. Diagnostic accuracy of history, physical examination, and bedside ultrasound for diagnosis of extremity fractures in the emergency department. Acad Emerg Med. 2013 Jan;20(1):1-15.

Last Reviewed August 2013



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