What is the clavicle?

The clavicle is also known as the collarbone and runs along the top of the chest connecting the sternum (breastbone) to the scapula (shoulder blade). The clavicle acts to connect the arm to the rest of the body. It can be felt and seen on the front of the body in the area between the neck and shoulder.

What are clavicle fractures?

The collarbone is one of the most commonly fractured bones among children and teens. This is because it takes on a large portion of the stress during a fall or direct blow to the upper body.

Clavicle fractures can be classified based on where the fracture is located on the bone:

• Type 1: Middle third – most common
• Type 2: Lateral third (outer)
• Type 3: Proximal third (inner) – least common

Causes:

Many collarbone injuries occur during sports, particularly contact sports like football, hockey, and lacrosse. They can also occur in sports like biking, skateboarding, and skiing due to high impact falls.  These can also occur during the delivery of a baby and are known as “birth fractures”.

Signs and Symptoms:

A broken collarbone will typically manifest with pain over the affected area. Other symptoms may include:

• Swelling and bruising along the collarbone
• Difficulty moving the affected arm
• Pain with movement of the affected arm or shoulder
• Hearing or feeling a “grinding” or “crackling” when moving the arm or shoulder
• A visible deformity around the collarbone
• Slumping of the shoulder on the affected side

Diagnosis:

A Campbell Clinic Pediatric orthopedic physician will diagnose a fractured clavicle during physical exam.

The doctor will ask about the injury and associated symptoms. During the physical exam, the doctor will test for signs of vascular and nerve damage and may also apply gentle pressure along the collarbone to determine where the fracture is.

After doing a physical assessment, the physician will typically order an X-ray of the affected side to confirm diagnosis and locate the exact area of fracture along the collarbone. In cases with multiple fractures or complications, a CT scan may be necessary.

Treatment:

Treatment plans for collarbone fractures depend on the type and severity of the fracture. An orthopedic surgeon will work with the patient and family to create a tailored treatment plan.

Most collarbone fractures, especially in children less than 12 years old due to the tremendous healing potential can be treated without surgery.  More complicated cases, especially those in adolescents may require surgery.

Non-Surgical Treatment:

If the child is less than 12 years old and there are no major complications with the fracture, treatment usually consists of the following:

• Icing the affected area to reduce pain and swelling
• Wearing a sling or shoulder immobilizer to support the arm
• Pain management (Ibuprofen or Acetaminophen)
• Physical therapy (as directed by your physician)

After about 2-4 weeks of immobilization, it is usually recommended to begin physical therapy and gentle range of motion exercises so that the surrounding muscles do not become too weak during recovery.

Surgical Treatment:

Surgery may be indicated in cases of severe or complicated fractures.

Examples of complicated fractures include:

• Compound (open) fractures- the bone broke through the skin
• Comminuted fractures- the bone broke into several small pieces

During surgery, the physician will fix the positioning of the bone to align where it broke. Special screws and plates may be used to hold the bone in place until it heals. These plates and screws do not need to be removed after healing unless they cause irritation.

After surgery, the arm should be supported in a sling or immobilization device for 7-10 days. Gentle motion exercises may be suggested by the physician after a few weeks of healing. Typically, physical therapy to strengthen the surrounding tissue is necessary.

Outlook (Prognosis):

In children, the bone will usually heal by about 6-8 weeks, during which time physical therapy strengthening exercises may begin.

Typically, children can return to full activity and sports after 2-3 months of recovery, but it is recommended to consult your orthopedic physician prior to returning to sports.

Most children and teens experience a full recovery from clavicle fractures with proper treatment.