Clavicle fractures are one of the most common fractures in the upper limb. The clavicle, or collarbone as it is commonly called, helps to connect the upper limb to the trunk of the body. When discussing clavicle fractures, we tend to divide them into 3 groups: Lateral fractures (fracture of the outer end of the collar bone), mid-shaft fractures (most common), and medial fractures (fracture of the inner end of the bone near the breastbone or sternum). Medial clavicle fractures are rare.
Most fractures of the clavicle are caused from a fall on the outstretched hand, and some (lateral fractures) can be as a result of falling directly on to the side of the shoulder. Common causes of clavicle fractures include, falling of pushbikes or motorbikes, contact sports such as rugby, skiing injuries, and falls from horses. Fractures are common in all age groups.
How is a clavicle fracture treated?
How a fracture is treated depends on the location of the fracture in the bone, the amount of displacement, and the chances of the fracture not healing (non-union).
The majority of fractures of the clavicle are treated without an operation in a sling for up to 6 weeks. While in a sling, patients are encouraged to do exercises for the shoulder, elbow, wrist, and hand. You can see these exercises here.
Some clavicle fractures such as significantly displaced lateral and mid-shaft clavicle fractures may require surgery to reduce the fracture in order to allow healing and prevent the bone from healing in a poor position (mal-union).
What tests need to be done to diagnose a fracture of the clavicle?
Most fractures of the clavicle are easily diagnosed with simple xrays. In some cases when planning surgery for complex fractures, or trying to assess fracture healing, a CT scan may be required to look at the fracture in more detail.
How long does it take for a fracture of the clavicle to heal?
Most fracture of the clavicle heal within 6 weeks, some can take longer to heal (between 3 to 6 months), and some never heal (non-union). If a clavicle fracture does not heal within 6 months, we consider it a non-union. Mid-shaft fractures of the clavicle have an 85% chance of healing without the need for surgery. Several factors can affect fracture healing and we discuss these in the video below:
Surgery doesn’t help a fracture to heal quicker, the biological healing process takes the same time with surgery or without. What surgery aims to achieve is to bring fracture fragments into an anatomical position so that the bone heals with the correct shape. Surgery for fractures is used to reduce the risk of a fracture not healing, or healing in a bad position. Surgery has the benefit of stabilising the bone so that pain settles quicker, and the patient can regain some early movement.
What does fractured clavicle surgery involve?
Most fractures of the clavicle that require surgery are treated with plating. This involves patients having a general anaesthetic and nerve block, then an incision is made over the clavicle, the fracture fragments are reduced, and a plate applied on to the bone.
Once the fracture is fixed, the wound is sutured, and a sling is applied. Patients usually go home the same day of surgery and clinic follow-up is arranged. We take xrays in clinic at 2 weeks, 6 weeks, and 3 months to follow fracture healing.
In some cases, although the sling is removed at 6 weeks, movement of the arm is limited to shoulder height for a further 6 weeks to protect fracture healing.
Once the fracture is healed patients can usually get back to full activity including contact sports. In most cases clavicle plates are left in for life but in some high-risk cases where there is a risk of future fracture, or in cases where plates or screws are prominent, a second operation may be needed to remove the plate and screws once the fracture is fully healed (usually 6 to 9 months after initial surgery).