Injuries and conditions

Clavicle (Collarbone) Fractures

Clavicle (collarbone) fractures

Clavicle (collarbone) fractures are very common and may occur due to a simple fall, playing sport, fall of a bicycle, or in a motor vehicle accident. It is important to understand the exact pattern of the fracture and the patients expectations around fracture healing and recovery. Any other associated injuries, such as the AC joint, should be identified. Most patients can be managed without surgery; if surgery is required it is best to undertake that sooner rather than later.

A clavicle fracture is a break in the collarbone – one of the main bones in the shoulder. A clavicle fracture often occurs after a fall directly onto the shoulder or an outstretched hand. It is a common injury and accounts for about 5% of all adult fractures. A broken collarbone can be very painful and can make it hard to move your arm. Patients often present immediately to the hospital with shoulder pain where a plain x-ray makes the diagnosis.

Medical diagram showing a Clavicle or Collarbone fracture

Clavicle fractures are most often caused by trauma – either a direct blow or fall onto an outstretched arm. Collision sports, such as rugby and soccer are also common mechanisms for clavicle fractures. Car accidents may also injure the shoulder and result in clavicle fractures as well as other broken bones around the shoulder.

In most cases the diagnosis is obvious and directly after trauma with immediate presentation to the emergency department. Signs and symptoms of a clavicle fracture include:

  • Visible deformity (or a bump) about the clavicle and shoulder girdle; in some cases there is skin “tenting” due to displaced fragments of bone being arranged more vertically
  • Bruising, swelling, and/or tenderness over the clavicle
  • A clicking or grinding sensation with arm movement, particularly overhead
  • Inability to raise arm due to pain
  • Sagging of the shoulder downward and forward; and possible loss of shoulder contour

Plain X-rays will almost always confirm the clinical diagnosis and demonstrate the number of fragments and the position of the fracture. It is important to exclude other fractures around the shoulder girdle, such as the proximal humerus (shoulder joint) and scapula (shoulder blade). The integrity of the acromioclavicular joint should also be checked. Occasionally a CT scan is needed to analyse the injury in better detail.

Xray showing a 4 part Clavicle (Collarbone) Fracture

Most cases can be managed without surgery with a sling and a graduated rehabilitation program allowing the bones to heal over time (3 months). A self directed rehabilitation program using the JPL program is commenced between 4-6 weeks after the fracture. Usually patients are followed up at 1-2 weeks with a repeat X-ray to confirm the fracture remains in good position. By six weeks patients can come out of sling and commence active range of motion. The fracture should unite by 3 months and at which point a strengthening program may be commenced.

After the clavicle has healed patients will note a lump may form where the fracture occurred – this is the new bone formation. This bump usually gets smaller over time but a small bump may remain permanently.

Some complications from non-surgical collarbone fracture treatment include:

  • Delayed fracture healing (delayed union), a higher risk in diabetics and smokers
  • Fracture does not unite (non-union), a higher risk in diabetics and smokers
  • The fracture may heal in the wrong position (malunion), a higher risk in comminuted fractures (fracture in many pieces) and those with a “Z’ type fracture configuration on X-ray

Surgery minimised the above issues and places the bones back in the correct position. Surgery does come with its own risks; however, it allows for faster recovery, improved function, and reduced chance of delayed union (collarbone slow to heal), non-union (collarbone not healed) and malunion (collarbone healed wrong).

In some cases surgery is a better option; the factors to consider are:

  • Displacement (fracture fragments further away)
  • Comminution (how many parts the fracture is in)
  • Other injuries (about the shoulder or elsewhere)
  • Occupation (overhead, heavy lifting, manual work etc)
  • Sporting demands
  • Pain management
  • Social situation

The decision to proceed with surgery is unique to each individual and based on their clavicle fracture pattern, social/work circumstances and expectations.

Dr Pant has extensive experience treating clavicle fractures and is highly skilled in the surgical repair of all clavicle fractures should that be required. As the lead shoulder trauma surgeon at St Vincent’s Hospital for many years, he has come to deal with a vast array of shoulder trauma cases and is well versed in guiding you to full recovery.

At Sydney Shoulder Unit we treat many types of clavicle fractures and keep aside “priority” appointment slots for an urgent review of patients who have sustained a fracture and need timely review and advice. Dr Pant has regular weekly lists and can accommodate urgent surgery should that be the best course of action.

Patient results

Broken Collarbone – Scooter accident

This 25 year old University Student came off his scooter and fell onto his left shoulder. He presented to the hospital with left shoulder pain and deformity. Plain x-rays demonstrated a comminuted (many parts) and displaced 4 part fractured left clavicle (collarbone). The options were discussed and he opted for surgery.

He underwent an ORIF (Open Reduction and Internal Fixation). We achieved anatomical reduction and stable fixation. Each of the fragments of bone were carefully mobilised and repaired back to the anatomical (normal) position. Immediately after surgery, his collarbone felt stable and he was pain free and comfortable. This is a common story from patients after the “unstable” collarbone is stabilised with surgery. He commenced JPL rehabilitation at 2 weeks and by 6 weeks had full symmetrical range of motion. By 12 weeks he had healed his broken collarbone (both on examination and imaging) and was back to all activities, including his beloved scooter.

Broken Collarbone – Cycling accident

This 29 year old lady fell off her bicycle and landed on her right shoulder. She presented to the hospital immediately with pain and deformity around the right shoulder. Clinically she had a displaced clavicle fracture and this was confirmed on X-ray.

The X-ray demonstrates a complex 3-4 part displaced clavicle fracture; the central fragment is in a few pieces and there appears to be a Z type fracture configuration.

The options were discussed with her – early surgery was recommended given her young age, fracture displacement and fracture comminution/configuration. She elected to proceed with surgery and she underwent Open Reduction and Internal Fixation (ORIF) the following day.

At surgery, we were able to reduce all of the small fragments of bone with separate small screws outside of the plate (2.4mm screws) and then achieve stable fixation with a plate and screws. X-rays taken during surgery confirmed anatomical reduction and stable fixation. She was pain-free the day after surgery and commenced JPL therapy at 2 weeks postoperatively. She went on to heal her fracture at the 3-month X-ray and is back to riding her bicycle (albeit more carefully).

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