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Clavicle Fracture

Aaron lost his balance while snowboarding and started to fall forward. He put out his arms to break his fall and came down hard on his right arm. He felt a sharp pain near his right shoulder and knew immediately that he'd injured something. His friend got the ski patrol, and they strapped Aaron into a sled and brought him down the mountain to a medical clinic.

The doctor at the clinic took a look at the area near Aaron's shoulder, which was already swollen and bruised, and told Aaron that he had most likely fractured his clavicle (collarbone). Aaron was sent to the hospital, where X-rays confirmed the doctor's diagnosis.

What Is a Clavicle Fracture?

Your clavicle is the bone that runs horizontally between the top of your breastbone () and shoulder blade (scapula). The clavicle (also called the collarbone) helps connect the arm to the body. You can feel it by touching the area between your neck and your shoulder. Most people can see the clavicle beneath the skin when they look in the mirror.

clavical_fracture_illustration

A clavicle fracture, also known as a broken collarbone, is one of the most common types of broken bones. Most clavicle fractures happen when someone falls onto a shoulder or outstretched hand, putting enough pressure on the clavicle to make it fracture or snap.

Most clavicle fractures heal on their own if the arm is properly immobilized in a sling and the injury is treated with ice and physical therapy. Sometimes, though, a clavicle injury may need surgery when it gets displaced or the break is particularly severe.

What Causes a Clavicle Fracture?

Clavicle fractures are common in contact sports like football, wrestling, rugby, lacrosse, and hockey. They also often happen in sports where there is a chance of falling hard, such as biking, skiing, snowboarding, and skateboarding. A clavicle also can fracture if the bone is hit directly, as in a car collision or other accident.

Clavicle fractures happen in three situations where stress is enough to break the bone:

  1. a person suffers a blow to the shoulder
  2. someone falls onto an outstretched arm
  3. the clavicle is hit directly (as in a collision)

A person's age plays a role in clavicle fractures: When we're young, our bones are still growing and are more susceptible to injury. Collarbones typically don't harden completely until a person is about 20 years old. That puts people younger than 20 at greater risk of a fracture.

What Are the Symptoms?

Signs that someone may have a clavicle fracture include:

  • pain in the affected area
  • difficulty moving the arm
  • swelling, tenderness, and bruising along the clavicle
  • increased pain when trying to move the shoulder or arm
  • a grinding or crackling sensation when trying to raise the arm
  • a bulge above the break (in rare cases, the broken end of the bone might even penetrate the skin and be exposed)
  • the shoulder sags down and forward

What Should You Do?

If you think you've fractured your collarbone, you'll want to see a doctor. Your doctor will first ask questions about how the injury happened and what symptoms you're feeling. The doctor will examine your shoulder and may press gently on your clavicle to see if it is tender. This will also help the doctor find out where the fracture is and make sure no nerves or blood vessels are damaged. This part of the exam also might include checking the feeling and strength in your arm, hand, and fingers.

If the doctor thinks you have a broken collarbone, he or she will order X-rays of your shoulder and the affected area. X-rays will help the doctor pinpoint the location of the break and decide how severe it is. X-rays also let doctors see if other bones are broken.

If other bones are broken or if the doctor needs to see the fracture in greater detail, he or she may ask you to get a computerized tomography (CT) scan.

How Can You Prevent a Clavicle Fracture?

Because clavicle fractures happen suddenly and unexpectedly, it can be hard to prevent them. But you can take a few precautions to decrease your risk:

  • When participating in contact sports, wear all the recommended protective gear and learn the proper techniques for your sport. Knowing the right way to play decreases the chances of an awkward fall or unexpected blow.
  • Keep your bones strong by eating a well-balanced diet. Be sure to eat lots of vegetables and foods that are rich in calcium and vitamin D to help build strong bones.
  • Do strength training and stretching to build strong, flexible muscles. Muscles that are strong and flexible will help support your bones better and keep you agile and less likely to experience a hard fall. A proper warm-up, including dynamic stretching exercises, can help your muscles perform at their best during play.
  • Wear well-fitting, supportive footwear that's right for your sport.

How Are Clavicle Fractures Treated?

Treating a clavicle fracture depends on the type of fracture and how severe it is. Most clavicle fractures can be treated with simple methods.

However, fractures where the bone fragments on each side of the break are severely shifted (displaced fractures) and fractures where the bone is broken into several pieces (comminuted fractures) may require surgery to ensure they heal properly. Compound fractures, where the broken bone pierces the skin, require immediate treatment to reduce the risk of an infection.

For fractures where the bone fragments stay aligned, doctors will recommend the following treatments:

  • Ice. To help control the pain and swelling associated with a clavicle fracture, apply ice packs to the affected area for the first 2 to 3 days after the injury. Don't put ice directly against the skin ― wrap it in a towel or other fabric.
  • Arm support. Keep your arm immobilized by using a sling or wrap. This keeps the bone in position as it heals and helps to control pain.
  • Medication. Talk with your doctor about what sort of medications (ibuprofen, acetaminophen) you should be taking to help reduce the pain associated with a clavicle fracture.
  • Physical therapy. You may lose muscle strength and range of motion in your shoulder while it is immobilized. Once the bones have started to heal, begin gentle motion exercises to reduce stiffness while you're wearing the sling (your doctor or a physical therapist can show you some). When the bone has healed completely, your doctor may recommend a more strenuous rehabilitation program to enable you to regain strength and flexibility in your shoulder.

Surgery

A severely displaced, compound, or may require surgery to realign the bone fragments and hold them in place while the bone heals. This is typically done by inserting special screws into the bone or by attaching metal plates to the outer surface of the bone. In general, the screws and plates will not be removed once the bone has healed unless they're causing irritation.

After surgery, doctors will often prescribe a therapy regimen to help a patient regain movement and strength in the shoulder. Typically, therapy will start with gentle motion exercises, and strengthening exercises will be added as the bone heals.

For teens, it usually takes around 6 to 8 weeks for a clavicle fracture to heal ― although it all depends on the fracture. Some will take longer.

During this time, it's important to take it easy so the bone doesn't get re-injured. Keep in touch with your doctor during the healing process so you know when it's OK to go back to normal activities.

Reviewed by: Alfred Atanda Jr., MD
Date reviewed: September 2014