Clavicle Fractures
Dr. Jonathan Piposar is an orthopaedic surgeon practicing in Niantic, CT. Dr. Piposar specializes in the diagnosis, treatment and rehabilitation of injuries, diseases and disorders of the bodys musculoskeletal system. As an orthopaedic surgeon, Dr. Piposar tends to bones, ligaments, muscles, joints, nerves and tendons.... more
One of the more common fractures that is seen involving the shoulder is a fracture of the collarbone, otherwise known as the clavicle. The clavicle is a bone that can be easily felt underneath the skin and its purpose is to assist with motion of the shoulder. Due to the fact that there is not much soft tissue, such as muscle and fat, that surrounds it, the clavicle is prone to fracture when someone sustains a direct fall on it. Examples of common clavicle fracture injuries are being tackled in a game and having one’s shoulder driven into the ground or falling off a bicycle or dirt bike.
When the clavicle is fractured, patients usually know that something is wrong. Sometimes they hear a ‘crack’ when the bone breaks. Other times patients notice a significant deformity involving their shoulder and have a significant loss of motion because of pain associated with movement. If there is concern for a fracture, the best course of action is to immobilize the shoulder in a sling and present to an emergency room, urgent care clinic, or orthopedic office for evaluation and x-rays as soon as possible. X-rays will visualize the fracture right away and determine if the fracture needs surgical treatment or not.
Fortunately, most clavicle fractures can be treated non-operatively. One of the main criteria orthopedic surgeons use to evaluate whether a fracture needs to be surgically treated is the displacement of the fracture or assess how far away the bone fragments are from each other. Generally, clavicle fractures do not sustain significant displacement which means they heal well with non-operative treatment. This treatment entails resting the affected arm in a sling for a couple weeks for pain control purposes then having one gradually work on regaining shoulder motion. Range of motion exercises usually become easier around 4-6 weeks after the injury because the bone has started to heal. Most motion has returned around 6-8 weeks and full strength returns around 10-12 weeks. Routine follow-up occurs throughout this period to ensure the bone is healing and the patient is doing well.
On the other hand, fractures that sustain significant displacement or are in multiple pieces have a higher likelihood of requiring surgery to correct the deformity. Recent research demonstrates improved function, less pain, and better healing rate of these displaced fractures when compared to non-operative treatment. Surgical treatment often requires the placement of a plate and screws across the fracture site after realigning the fragments. Once the surgery is completed, the bone will heal over the next several weeks. A sling is often utilized for 1-2 weeks after surgery but then it is discontinued and patients will find that their motion returns quickly. The major drawback of surgery is a scar forming where the incision is made as well as plate irritation. This complication can be addressed with plate removal but it does require another surgery which can happen in up to 30% of patients.
While fractures of the clavicle are more common in the young, they can happen to middle-aged adults and the elderly after simple trip and falls. While most of these fractures can be treated non-operatively, even those fractures that do require surgery go on to have an uneventful recovery. Regardless of treatment method, a short period of immobilization is followed by a gradual return of motion and then strength. By 10-12 weeks after the injury has occurred, usually the patient is back to enjoying all activities in life pain free.
