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Shoulder

Clavicle Fractures

A clavicle fracture (collarbone) is a common fracture, and often occurs during a fall onto the shoulder or an outstretched arm. There is generally an immediate onset of localized pain at the fracture site with or without an obvious deformity.

Anatomy

The clavicle is located between sternum and the scapular (shoulder blade). The clavicle lies above several important neurovascular structures, yet, they are only rarely injured during a clavicle fracture.

Symptoms

Clavicle fractures result in localized pain, difficulty lifting the arm, a “bump” at the fracture site and often local swelling and ecchymosis.

Physical Examination and Work-up

On examination, tenderness is appreciated at the fracture site. Tenting of the skin should be evaluated immediately in an emergency department, as the bone fragment may puncture the skin, creating an open fracture.

Imaging

X-rays provide the precise location and type of clavicle fracture. Rarely, a CT scan is ordered to a more detailed view of the fracture and its fragments.

Fracture classification is based on location (distal, midshaft medial), amount of displacement, and complexity.

Management of Clavicle Fractures

Non-operative Treatment

The fracture classification details dictate treatment needs. Fractures appropriate for nonsurgical care begin with short term immobilization (sling), over the counter medications and a course of physical therapy. X-rays are performed at future visits to assess for proper fracture healing.

Surgical Treatment

If the fracture is complex or has severe displacement, surgery may be recommended. Commonly, open reduction and internal fixation is performed, which includes reducing the fracture fragments back in place and securing them together with a metal plate. After surgery, X-rays are performed to assess for proper fracture healing. Plates and screws are not routinely removed after the bone has healed. As with nonsurgical management, a course of physical therapy is prescribed to optimize recovery and return to functional activities.


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