Broken Collarbone or Clavicle Fracture

Broken Collarbone or Clavicle Fracture is one of the common injuries observed in all age groups. A clavicle is also known as the collarbone. The clavicle or collarbone is often broken or fractured following direct trauma to the front of shoulder joint. Fall from height or motor vehicle accident causes direct shoulder joint injury and direct impact resulting in broken collarbone or clavicle fracture.

Broken Collarbone or Clavicle Fracture

What is Broken Collarbone or Clavicle Fracture?

  • The clavicle or the collarbone is the bridge between the shoulder joint and sternum.
  • The clavicle forms a joint on medial (inner) side with sternum and acromion on lateral (outer) side
  • Clavicle prevents push and rotation of shoulder joint towards front or inner side of the shoulder joint.
  • Clavicle protects vital structures like upper 1/3rd of lung, arteries, nerves and veins.
  • The fracture fragment in most of the cases protrudes outward because of anatomical shape and curvature of clavicle.
  • The clavicle or collarbone is quite a long bone and usually fracture to this bone occur right in the center of the shaft.
  • Broken Collarbone or Clavicle fracture may be associated with dislocation at its attachment to the ribcage or shoulder blade.

Causes of Broken Collarbone or Clavicle Fracture

Sports Injury Resulting in Broken Collarbone or Clavicle Fracture-

  • Fracture may occur because of direct impact over clavicle by a helmet of another player or crushing fall over the clavicle.
  • Athletes participating in sports may end up with Broken Collarbone or Clavicle fracture.
  • Injuries caused during participation in following sports may result in Broken Collarbone or Clavicle fracture-
    • Rugby
    • Football
    • Soccer

Car Accident Resulting in Broken Collarbone or Clavicle Fracture

  • Automobile accident results in head-on collision, side impact or rare impact.
  • Broken Collarbone or Clavicle fracture is observed following head-on collision and side impact collision of motor vehicles.
  • The steering wheel, dashboard or door of the car caves in and causes severe direct impact resulting in broken collarbone or clavicle fracture.

Broken Collarbone or Clavicle Fracture as a Result of Work Injury

  • Worker's involved in operating heavy equipment may get into accident and fall resulting in broken collarbone or clavicle fracture.

Broken Collarbone or Clavicle Fracture Due To Osteoporosis

  • Elderly patient suffering with osteoporosis may sustain Broken Collarbone or Clavicle Fracture following fall or moderate impact.

Broken Collarbone or Clavicle Fracture In Infants

  • Broken Collarbone or Clavicle Fracture can also occur at the time of birth of a baby when it is passing through the birth canal.

Types of Broken Collarbone or Clavicle Fracture

  • Hairline fracture of Collarbone or Clavicle
  • Non-displaced fracture of Collarbone or Clavicle
  • Displaced fracture of Collarbone or Clavicle
  • Comminuted fracture of Collarbone or Clavicle
  • Compound fracture of Collarbone or Clavicle

Symptoms of Broken Collarbone or Clavicle Fracture

Some of the Symptoms of Broken Collarbone or Clavicle Fracture are:

Symptoms of Pain as a result of Broken Collarbone or Clavicle Fracture -

  • Severity of the pain depends on type of fracture of Collarbone or Clavicle
  • Hairline fracture of Collarbone or Clavicle is less painful than displaced fracture.
  • Displaced and comminuted fracture of Collarbone or Clavicle is very painful.
  • Pain becomes severe following palpation or examination of fractured site of Collarbone.

Symptoms of Swelling as a result of Broken Collarbone or Clavicle Fracture -

  • Clavicle is a long bone. Shaft of the clavicle lies between breastbone (sternum) and shoulder joint. The fracture of the clavicle is observed anywhere along the shaft of the clavicle.
  • The clavicle looks swollen over the fracture site.
  • Swelling is caused by soft tissue edema, blood clot or protrusion of fractured fragments.
  • Minimum swelling is observed in hairline fracture of Collarbone or Clavicle.

Symptoms of Deformity as a Result of Broken Collarbone or Clavicle Fracture -

  • Deformity may be caused by protrusion of fractured segment.
  • Hairline fracture of collarbone or clavicle is often presented with minimum deformity.
  • Large deformity is observed following fracture of clavicle, which is displaced or comminuted.

Symptoms of Restricted Shoulder Joint Movements in Broken Collarbone or Clavicle Fracture -

  • Shoulder joint movements are restricted if broken collarbone or clavicle fracture is displaced, compound, or comminuted fracture.
  • Shoulder joint movements are not restricted following hairline type of clavicle fracture.
  • Movement of shoulder joint causes pull and push over clavicle. Pull and push of fractured fragments often causes severe pain.

Bruising Over Clavicle Bone-

  • Subcutaneous bleeding following injury of the clavicle causes bruising over broken collarbone or clavicle fracture site.
  • Bruising is purplish discoloration of skin and subcutaneous tissue.

Symptoms of Subclavian Artery Injury Due To Broken Collarbone or Clavicle Fracture -

  • Broken collarbone or clavicle fracture causes subclavian artery tear or laceration.
  • Tear of subclavian artery causes life-threatening bleeding.
  • Laceration of subclavian artery causes aneurysm of subclavian artery.1

Diagnosis of Broken Collarbone or Clavicle Fracture

Findings of Clinical Examination 2-

  • For diagnosis of Broken Collarbone or Clavicle Fracture, the treating physician will first inquire about the history of the patient as to how the injury occurred.
  • After a detailed history taking, the physician will then examine the shoulder.
  • As stated, in Broken Collarbone or Clavicle Fracture there is an obvious deformity at the fracture site which itself will confirm the diagnosis.
  • Apart from this, gentle palpation over the injured area will cause significant pain.

Radiological Studies-

  • Once a diagnosis of broken collarbone or clavicle fracture has been established, the physician will then order radiological studies in order to locate the exact position of the fracture and the extent of damage.
  • This is done through x-rays.
  • A complete shoulder x-ray might be taken to look for additional injuries.
  • In cases, where other bones are also fractured, a CT scan may also be ordered.

Treatments For Broken Collarbone or Clavicle Fracture

The treatments for Broken Collarbone or Clavicle Fracture can be both conservative as well as surgical.

Nonsurgical Treatment of Broken Collarbone or Clavicle Fracture

Indications For Conservative Treatment of Broken Collarbone or Clavicle Fracture-

  • Treatment options of conservative versus surgical therapy for broken collarbone or clavicle fracture depends on type of fracture and complications caused by injury.3
  • Hairline and non-displaced fracture of collarbone or clavicle are treated with conservative treatment.
  • If broken collarbone or clavicle fracture are not displaced from their natural position and are adequately aligned, then surgery is not required and Broken Collarbone or Clavicle Fracture heals without the need for any sort of surgery.

Supportive Aids For Broken Collarbone or Clavicle Fracture:

  • Immediately post injury of broken collarbone or clavicle fracture, a sling or an arm support may be placed as comfort measure. These need to be worked diligently so that the arm heals uneventfully.

Medications For Broken Collarbone or Clavicle Fracture:

  • Pain medications may be prescribed for relief of pain when the broken collarbone or clavicle fracture is in the healing phase.

Physical Therapy (PT) For Broken Collarbone or Clavicle Fracture:

  • While in the sling, there is significant loss of muscle strength. For this physical therapy is prescribed for strengthening of the shoulder.
  • PT for broken collarbone or clavicle fracture will start with gentle shoulder and elbow exercises, which prevents stiffness and weakness.
  • This will be gradually advanced to more strenuous exercises.

Physician Followup:

  • Diligent followup with the treating physician is imperative while the broken collarbone or clavicle fracture is in the healing process.

Surgical Treatment For Broken Collarbone or Clavicle Fracture

Indications for Surgery:

  • In case of displaced Broken Collarbone or Clavicle Fracture, surgery is the recommended choice.
  • A surgical procedure will be done to realign the collarbone or the clavicle and hold them in position as they heal. The surgical procedure will involve the following:

Plates and Screws:

  • The fragments of collarbone or clavicle are repositioned into their normal position and held in place with screws or metal plates.
  • Following surgery, there may be an area of numbness just beneath the incision, which will get better and normal sensation will return over a period of time as the wound heals.
  • These plates and screws are not removed even after complete healing unless they become a source of discomfort for patient.

Pins:

  • They are used to keep the broken collarbone or clavicle fracture in good alignment.
  • This is done through small incisions.
  • Since the pins generally irritate the skin, hence they are removed once the fracture completely heals.

Bone Graft and Fixation of Fractured Fragments:

  • Broken collarbone or clavicle fracture not responding to conservative treatment is treated with bone graft and external fixation using screw and plates.4
  • Recovery and results of broken collarbone or clavicle fracture are much better when bone graft are used.4

Post Surgery Rehabilitation For Broken Collarbone or Clavicle Fracture

  • Surgery causes tissue trauma in addition to the trauma caused by injury resulting in broken collarbone or clavicle fracture. Four to six weeks after surgery, patient is scheduled for physical therapy and rehabilitation.
  • Physical therapy will gradually start with gentle motion exercises and then slowly advance to strengthening exercises.

Surgical Complications Involving Broken Collarbone or Clavicle Fracture:

  • Smokers, diabetics, and the elderly population are at increased risk for complications postprocedure.
  • Following complications are observed after surgery for broken collarbone or clavicle fracture:
    • Infection
    • Bleeding
    • Pain
    • Blood clots
    • Nerve injury causes numbness5
    • Brachial plexus injury6
    • Difficulty with bone healing
    • Injury to the lungs
    • Skin irritation due to hardware

Watch 3D Video of Surgery for Broken Collarbone

Overall Outcome of the Treatments For Broken Collarbone or Clavicle Fracture

  • Usually, Broken Collarbone or Clavicle Fracture takes quite a few months to completely heal although it may become longer for smokers and diabetics.
  • A majority of people after broken collarbone or clavicle fracture return to their activities within 90 days post-injury.
  • The treating physician is the best person to recommend as to when to return to activities following broken collarbone or clavicle fracture.
  • Once the fracture of collarbone or clavicle is completely healed, it is safe to return to normal work and sporting activities.

Exercises For Broken Collarbone or Clavicle Fracture

These exercises are to be done during the recovery phase or once the broken collarbone or clavicle fracture is healed.

Broken Collarbone or Clavicle Fracture Exercise #1 : Shoulder Blade Squeezes

  • To do this exercise, start by standing tall with the back straight.
  • Squeeze the shoulder blades together as much as possible without aggravating pain.
  • Maintain this position for about 5 seconds and repeat around 10 times.

Broken Collarbone or Clavicle Fracture Exercise #2: Pendular Exercises

  • Start this exercise by leaning forwards with uninjured arm placed on a table.
  • Keep the back straight and relax the shoulder.
  • Now, gently swing the affected arm forward and backward as far as possible without aggravating pain.
  • Do it for around 10 times. Now, do the same exercise by moving the arm sideways.

Broken Collarbone or Clavicle Fracture Exercise #3: Pendular Circles

  • Start this exercise by leaning forwards with uninjured arm placed on a table.
  • Keep the back straight and relax the shoulder.
  • Now, slowly swing the injured arm in a circular fashion clockwise as far as possible without increasing pain.
  • Repeat this by moving it anticlockwise. Do it about 10 times in each direction.

References:

1. Emergency bedside sonographic diagnosis of subclavian artery pseudoaneurysm with brachial plexopathy after clavicle fracture.

Gullo J1, Singletary EM, Larese S.

Ann Emerg Med. 2013 Feb;61(2):204-6.

2. Clavicle fractures.

Pecci M1, Kreher JB.

Am Fam Physician. 2008 Jan 1;77(1):65-70.

3. Surgical versus conservative interventions for treating fractures of the middle third of the clavicle.

Lenza M1, Buchbinder R, Johnston RV, Belloti JC, Faloppa F.

Cochrane Database Syst Rev. 2013 Jun 6;6:CD009363.

4. Outcomes from surgical treatment of middle-third clavicle fractures non-union in adults: a series of 21 cases.

Faraud A1, Bonnevialle N1, Allavena C1, Nouaille Degorce H1, Bonnevialle P1, Mansat P2.

Orthop Traumatol Surg Res. 2014 Apr;100(2):171-6.

5. Cutaneous hypoesthesia following plate fixation in clavicle fractures.

Wang L, Ang M, Lee KT, Naidu G, Kwek E.

Indian J Orthop. 2014 Jan;48(1):10-3.

6. Iatrogenic postoperative brachial plexus compression secondary to hypertrophic non-u\nion of a clavicle fracture.

Thavarajah D1, Scadden J.

Ann R Coll Surg Engl. 2013 Apr;95(3):e55-7.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: April 22, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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