Clavicle fracture (broken collar bone)
The clavicle (collar bone) is an S-shaped bone that connects the sternum (the breast bone) to the scapula (shoulder blade bone). Injuries to the clavicle are fairly common and are often easily recognized. The clavicle is the most frequently fractured bone during childhood. Most fractures occur in the middle of the bone.
How it occurs
Clavicle fractures most commonly occur with a fall onto the side of the shoulder. Fractures can also be due to a direct blow to the clavicle, for instance, if an athlete is hit in the front of the shoulder with a hockey stick or baseball. Less commonly, clavicle fractures may happen with a fall onto an outstretched arm. Clavicle fractures are most common in athletes who participate in football, hockey, and soccer or in sports with a high risk of falling, such as biking or horseback riding.
Signs and symptoms
Clavicle fractures are often easily recognized. As with any broken bone, affected individuals have immediate pain and may feel or hear a snap or crack at the time of injury. Pain and swelling are common. For most individuals with clavicle fractures, the contour of the fracture on the affected side looks abnormal when compared to the uninjured side. Many individuals who sustain clavicle fractures feel more comfortable holding the arm in a cradled position.
Risk factors
Athletes who participate in contact sports, such as hockey, football and lacrosse, and sports with a high risk of falls are more likely to sustain a clavicle fracture. Using adequate padding during contact sports and taking measures to prevent falls will reduce the risk of clavicle fracture.
Diagnosis
The doctor will take a detailed history of the injury and examine the shoulder to make the diagnosis. In addition, the doctor will check feeling in the arm and circulation to evaluate for nerve or blood vessel injury related to the clavicle fracture. X-rays are obtained to evaluate fracture alignment and position, identify other fractures related to the injury, and to confirm proper healing.
Treatment
Immediate treatment is focused on relieving pain and swelling with icing, rest, and pain medication. Holding the arm at the side or cradled by the other arm also often helps relieve pain. In younger children who have significant growth remaining, clavicle fractures rarely require surgery. Most clavicle fractures heal very well with minimal treatment. The doctor may prescribe a sling or a shoulder strap for comfort and to keep the ends of the bone from moving. Clavicle fractures generally heal in 3-6 weeks. There may be a residual bump left at the fracture site after healing is complete. In younger children, the bump tends to resolve over months or years. However, in older children, teens and young adults, the bump may persist. Having a small bump at the site of the fracture does not usually result in pain or difficulty using the arm.
Surgery may be required if the fracture breaks the skin, if there is nerve or blood vessel damage, or if the fracture pieces are significantly displaced, particularly in older children and teens. Clavicle fractures rarely fail to heal on their own. Surgery may be necessary for a fracture which does not show signs of healing in the first 4-6 weeks after injury. Surgery should be avoided for purely cosmetic reasons as risks of surgery include infection, poor fracture healing, and prominent scarring.
Returning to activity and sports
The goal is to return to activity as quickly and safely as possible. Returning to play prior to full healing puts the patient at risk for re-injury. Determining when to return to activity depends on the location and severity of the clavicle fracture, the amount of healing seen on x-ray, and the sport played.
Recovery involves a gradual return to activity. Once pain subsides, range of motion exercises may begin without the sling to prevent joint stiffness. Once the fracture is healed, there is no tenderness and there is full and painless range of motion of the shoulder with nearly full strength, participation in non-contact sports may begin. This is typically achieved by about 6 weeks from the time of the injury. The doctor may delay the return to contact sports for several months, depending on the severity and location of the fracture. Young children tend to heal fractures very quickly and are often able to return to sports more quickly than adolescents and adults with the same type of injury. For extra protection during contact sports, some athletes may consider using a donut pad or fiberglass shoulder shield worn under the jersey or pads.