Clavicle Fracture (Broken Collarbone)

Basic Anatomy

The clavicle or collarbone is an S-shaped bone that connects your scapula or "shoulder blade" to your sternum or "breastbone." The clavicle connects your arm bones to the rest of your skeleton. The clavicle has very little muscle or other soft tissues around it, which is why it is so easy to feel under your skin.

Outline of clavicle and sternum — Figure 1: The clavicle the dashed line is your clavicle or collar bone. Some people have very prominent clavicles that are easy to see. The trapezoid shape is the sternum location where the clavicle attaches to your breastbone.

Drawings showing clavicle — Figure 2: Skeleton showing the clavicle and how it attaches to the shoulder blade (scapula) and sternum (breastbone).

Mechanism and Epidemiology

The clavicle is the most commonly broken bone. The limited amount of muscle and soft tissue around the clavicle makes it easily injured. The most common causes for broken clavicles are direct blows or impacts, including a fall. The clavicle can break near the shoulder, the sternum, or in the middle (most common).

Figure 3: Fracture in the middle portion of the clavicle.

Figure 4: Fracture at the far end of the clavicle near the shoulder and attachment to the shoulder blade.

Initial Treatment

Clavicle fractures usually hurt a lot, and it often hurts when you try to move your arm. You may see or feel a bump where the bone is broken, and sometimes your shoulder may look like it droops down lower than your other side. When you see a doctor, they will examine your shoulder and arm and get an x-ray if they think it may be broken. If your bone is not too displaced and did not come through the skin when it broke, it may be treated with a sling and limited weight bearing. You should make an appointment with an orthopaedist or your primary care doctor for follow-up. People typically do not need to be admitted to the hospital for an isolated clavicle fracture.

General Treatment

Most clavicle fractures can be treated without surgery. The broken bone will take 3-4 months to heal. If surgery is not needed, there may be a time during which movement and lifting is limited. Some clavicle fractures may benefit from surgery. The discussion about your injury and the pros and cons of surgical vs. non-surgical treatment can be had with an orthopaedic surgeon. Surgery is required if the bone came through your skin or is close to breaking through the skin. Otherwise, there are few absolute reasons to do surgery. If surgery is needed, an incision (or "cut") is made over the clavicle, the bones are realigned, and metal plates and screws are used to fit the bones back together.

Figure 5: X-rays of a clavicle fracture with a piece in the middle that was sticking up under the skin. X-rays from 6 months later showing bone healing and remodeling (reshaping) of the fracture pieces.

Figure 6: X-rays of a patient with a clavicle fracture initially and 6 months later. He had a fibrous union, meaning the bone healed back together not with bone but with connective fibrous scar tissue. They had no pain, full motion and normal strength of the arm.

Figure 7: A clavicle fracture after it has been fixed with a plate and screws.

Post-operative Care

While your broken clavicle is healing, you may not be able to lift heavy objects or fully move your shoulder. This can be because of pain and/or instructions from your surgeon. Sometimes physical therapy is prescribed to help with motion and lifting after surgery.
Lying flat in a bed after a clavicle fracture can cause pain, so it may be more comfortable to sleep in a recliner or upright position. A sling may also be used for comfort. It is important to remove the sling several times a day and to move your elbow, wrist, and hand (and shoulder if possible) to prevent stiffness. The ability to move your shoulder and lift more will get easier as your bone heals. It is important to follow instructions from your surgeon regarding your post-operative care for best results.

Long Term

Long-term issues after clavicle fractures can include a deformity such as a bump, or a shoulder that appears lower than the other side. The "bump" may decrease in size over time, but it may always look and/or feel different from your other side. Your shoulder may also feel more tired or stiffer compared to before your injury.

If surgery is done, you may have numbness over the chest around the scar. The plate and screws may also be felt under the skin. This may make wearing a backpack, shirts, or bras uncomfortable. If they are bothersome, the plate and screws may be removed after the fracture has healed. On rare occasions, the bone does not heal or there is a complication like an infection. In these cases, another surgery may be needed.

While most clavicles can heal without surgery, sometimes they do not heal, or heal in a position that causes discomfort. Surgery to get the clavicle to heal, or to line up the broken pieces can be done at any time. However, this surgery may be more difficult and may have more risks if a long time has passed. If you are still having difficulty with your clavicle, you can talk to your surgeon about whether or not you may benefit from surgery.

Figure 8: A scar and some prominence of the plate after a clavicle was fixed with surgery.

Physical Therapy Videos - Shoulder

More Information

---

Christopher Domes, MD
Edited by the OTA Patient Education Committee and Steven Papp, MD (section lead)
All x-rays and pictures taken from the personal collection of Dr. Domes