What is a Clavicular Fracture?
A clavicular fracture, or broken collarbone, occurs when there is a partial or complete break in the clavicle due to trauma. This shoulder injury is common across all age groups but is particularly prevalent in newborns after a difficult delivery and in young athletes engaged in contact sports.
Clavicular fractures account for approximately 5% of adult fractures and 10% of pediatric fractures seen in emergency departments in the U.S. (Robinson et al., 2022). While children’s clavicle fractures often heal quickly without complications, healing in adults may take longer and has a higher risk of malunion (improper healing).
Anatomy and Function of the Clavicle
The clavicle is a slender, S-shaped bone that connects the shoulder girdle to the trunk. It serves several key functions:
Provides structural support to the shoulder
Protects major blood vessels and nerves, including the brachial plexus
Serves as an attachment site for muscles and ligaments
Due to its exposed position and thin structure, the clavicle is highly susceptible to fractures, especially in its middle third, where the bone is weakest.
Causes of Clavicular Fractures
Falls – A direct fall onto the shoulder or an outstretched arm (FOOSH injury) is a common cause.
Direct trauma – A strong blow to the collarbone, such as during contact sports (football, hockey, wrestling) or vehicle accidents.
Birth trauma – Newborns can sustain clavicle fractures during difficult or prolonged vaginal deliveries.
Signs and Symptoms
Severe pain in the affected shoulder, which worsens with movement
Swelling, bruising, and tenderness over the fracture site
Visible deformity – The shoulder may appear shortened or dropped compared to the other side
Crepitus (grating sensation) – Suggests a complete bone break
Open fractures – Rare but may involve visible bone protrusion through the skin, leading to bleeding and an increased risk of infection
Diagnosis
A physician typically diagnoses a clavicular fracture through:
Physical Examination – Checking for deformity, pain, and range of motion limitations.
X-ray Imaging – Confirms the location and severity of the fracture.
CT Scan or MRI – Ordered if there is suspicion of associated injuries to blood vessels, nerves, or the lungs.
Treatment Approaches
Non-Surgical Treatment (Most Common Approach)
Immobilization – A sling or figure-of-eight brace is used to restrict movement and promote healing.
Pain Management – Over-the-counter NSAIDs (e.g., ibuprofen, naproxen) help reduce pain and swelling.
Cold Therapy – Ice packs applied for 15–20 minutes every 3–4 hours during the first 48–72 hours.
Physical Therapy – After 3–4 weeks, gentle range-of-motion exercises begin to prevent stiffness. Strengthening exercises follow after complete bone healing (~6–12 weeks).
Surgical Treatment (Indicated for Severe Cases)
Surgery is required in about 10–15% of clavicular fractures, particularly in cases of:
Severe displacement (bones are far apart or overlapping)
Open fractures (bone pierces the skin)
Neurovascular injury (damage to nerves or blood vessels)
The most common surgical method is open reduction and internal fixation (ORIF) using a metal plate and screws. In some cases, an intramedullary rod or pin is used instead.
Recovery and Rehabilitation
Bone Healing Time: Typically 6–12 weeks, depending on age and severity of the fracture.
Return to Sports/Work: Low-impact activities can begin in 6–8 weeks, while full return to contact sports usually takes 3–6 months.
Physical Therapy Timeline:
Weeks 0–4: Immobilization, gentle pendulum exercises
Weeks 4–8: Active range of motion, light resistance training
Weeks 8–12: Strengthening exercises, return to full shoulder function
Complications and Long-Term Outlook
Nonunion or Malunion (5–10% of cases) – Bone fails to heal properly, sometimes requiring surgery.
Shoulder Weakness or Stiffness – Can be minimized with proper rehabilitation.
Osteoarthritis (Rare but Possible) – May develop in adjacent joints if fracture affects the acromioclavicular joint.
Conclusion
Most clavicular fractures heal successfully with non-surgical treatment, especially in children and young adults. However, surgical intervention may be required for severely displaced fractures or complications. Prompt diagnosis, proper immobilization, and a structured rehabilitation plan are key to achieving a full recovery.
References:
Robinson CM, et al. (2022). Clavicle fractures: Mechanism, diagnosis, and management strategies. The Journal of Bone and Joint Surgery.
Smith JB, et al. (2023). Treatment outcomes of displaced midshaft clavicle fractures: A systematic review. Orthopedic Reviews.
