Clavicle Fracture
What is the Anatomy of the Clavicle?
The clavicle, or collarbone, is an S-shaped bone that connects the sternum (breastbone) to the scapula (shoulder blade). It serves as a strut that holds the shoulder out from the chest, allowing proper arm movement and function. The clavicle also protects important underlying structures such as blood vessels and nerves. It has three parts: the medial (sternal) end, the middle third (shaft), and the lateral (acromial) end. Most fractures occur in the middle third, where the bone is thinnest and the forces transmitted through the shoulder are greatest.
How does a Clavicle Fracture Occur?
A clavicle fracture typically occurs after a fall directly onto the shoulder, a fall onto an outstretched arm, or a direct blow to the collarbone, such as in contact sports or traffic accidents. The middle portion of the clavicle is most commonly affected. In some cases, fractures occur near the shoulder joint (lateral third) or near the sternum (medial third). Patients often experience immediate pain, swelling, and difficulty lifting the arm.
What Is the Long-Term Consequence of Having a Clavicle Fracture?
If treated appropriately, most clavicle fractures heal well with minimal long-term issues. However, potential consequences may include:
Persistent pain or discomfort, especially if the bone heals with shortening or malalignment.
Visible deformity or prominence over the fracture site.
Shoulder weakness or fatigue during overhead or heavy activities.
Nonunion- where the bone does not fully heal.
How Does a Clavicle Fracture Get Diagnosed?
Diagnosis is based on the patient’s history, physical examination, and imaging studies:
History of trauma, often involving a fall or impact to the shoulder.
Physical examination may reveal swelling, bruising, deformity, or tenderness over the collarbone. The affected arm may hang lower than the uninjured side. The skin near the fracture can be tenting.
X-rays are the primary imaging tool used to confirm the fracture location, pattern, and degree of displacement.
CT scans may be used in complex or joint-related fractures to better assess the alignment and involvement of surrounding structures.
What Are the Indications for Treating a Clavicle Fracture Non-Operatively?
Non-operative management is appropriate for many clavicle fractures, especially those that are not significantly displaced. It is indicated in:
Minimally displaced or non-displaced fractures with good alignment.
Low-demand patients or children, who typically heal well with conservative treatment.
Fractures where bone ends are still in contact.
Treatment usually involves sling immobilisation for 3–6 weeks, followed by gradual physiotherapy to restore shoulder motion and strength. Pain relief, icing, and gentle activity modification support recovery. Most fractures heal within 8–12 weeks.
What Are the Indications for Treating a Clavicle Fracture Operatively?
Surgery may be recommended in the following situations:
Significantly displaced or shortened fractures (more than 2 cm).
Comminuted (multi-fragment) fractures with poor alignment.
Open fractures where the bone pierces the skin.
Fractures associated with neurovascular injury or skin compromise.
Nonunion or symptomatic malunion after failed non-operative treatment.
High-demand or athletic individuals who require early strength recovery and shoulder function.
Surgery typically involves fixation with a plate and screws or, in some cases, an intramedullary device. The goal is to restore alignment, stability, and shoulder function.
