Fracture of the clavicle

Autor: RAFAŁ CZEPUŁKOWSKI
Consultation MACIEJ PAWLAK
Date added 23.12.2024
Date of last revision 23.12.2024

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A clavicle fracture is a fairly common injury and accounts for about 5 percent of all fractures in adults. Very rarely, both clavicles are fractured. The injury usually occurs as a result of a fall on an upright arm, on which great pressure is exerted leading to a fracture of the bone or a direct fall on the shoulder. A broken clavicle can make it difficult to move the arm and is very painful, so it requires orthopedic assistance.

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In most cases, the frame is immobilized to stop movement of the upper limb while the bone heals. However, in more complicated fractures, where there is displacement of bone pieces, surgery may be required to anatomically realign the fragments and regain clavicle length.

Basic functions of the clavicle

The clavicle is one of the main bones of the shoulder girdle, which has a slender, somewhat sigmoid shape. It is the link between the sternum and the scapula, forming the sternoclavicular and shoulder-clavicular joints at their ends (proximal and distal). Although these joints have little mobility, they play a very important role for the stability of the shoulder girdle. Fractures of the clavicle can happen to people of any age. They are even more common in children. Each clavicle fracture is different. Most occur in the middle part, which is not reinforced by ligaments and muscles. Less frequently, the clavicle breaks at the point of attachment to the rib cage or scapula. Depending on the force of the impact, it may only break without displacement or break into many pieces.

How does a clavicle fracture occur?

The injury can occur during a fall or as a result of various types of traffic accidents involving, for example, a car and a bicycle, where the shoulder lands. A very common cause of broken clavicles is sports injuries. This largely affects younger people, as the clavicle fully hardens after the age of twenty. Those most prone to this type of injury are those who participate in so-called contact sports like ice hockey, soccer, handball or rugby. The main factor in a clavicle fracture is a fall, especially occurring at high speeds. This is why there are so many such injuries in downhill skiing, cycling or skateboarding.

Symptoms of a broken clavicle

The main symptoms of a broken clavicle are sharp pain in the shoulder, preventing movement of the upper limb, which may be accompanied by dizziness and nausea. Other signs of a fracture may include: visible displacement of bony elements, laxity and downward drooping of the arm, large local swelling, a pronounced crackling of the bone when trying to lift the arm forward.

When a clavicle fracture occurs:

  • acute pain in the clavicle,
  • inability to move the arm,
  • tenderness to the touch,
  • swelling, bruising,
  • bump, convexity of the fracture area.

How to treat a clavicle fracture?

First aid for clavicle fracture is very important. First of all, it consists in immobilizing the limb in the shoulder joint. This is to prevent the movement of bone fragments, which could significantly complicate the healing process. For this purpose, it is best to use a shoulder orthosis or an orthopedic vest that holds the upper limb to the chest. Of course, most clavicle fractures occur in the field, where we do not have access to such specialized equipment. In such a situation, it is necessary to make a makeshift sling, holding the upper limb to the torso with, for example, a triangular sling. With the shoulder secured in this way, you should go to a specialist as soon as possible.

Medical examination

If a clavicle fracture is suspected, diagnosis begins with a medical history and physical examination. The orthopedist will want to know under what circumstances the injury occurred, and then proceed to examine the shoulder. A fracture of the clavicle is usually accompanied by a deformity of the bone surface or a bump. Very rarely, the bone breaks through the skin. Fractured ends of the clavicle at the site of breakage can cause swelling of the skin. During palpation examination, gentle pressure at the site of the thickening causes pain. An important part of this examination is to check whether nerves or blood vessels were damaged at the time of the fracture. An imaging study is very helpful in diagnosis. X-rays can help locate the fracture and provide more detailed information about the type of fracture , and on occasion to rule out the coexistence of a clavicle fracture with additional injuries in the shoulder. Sometimes a CT scan is ordered to see the fracture gap in more detail.

Non-operative treatment and rehabilitation

When a clavicle fracture occurs without displacement of the bone, surgery is most often unnecessary. Such cases are statistically the most common. The doctor then moves on to non-surgical treatment, which involves bracing the arm with a shoulder brace. It is intended to help maintain the position of the arm and shoulder while the injury heals. On top of this, when clavicle pain is very bothersome, the doctor prescribes painkillers that can help relieve the discomfort. An important part of treatment is rehabilitation, which starts very early. It can be a bit painful, but it is designed to keep the arm mobile, preventing stiffness. Once the fractured clavicle begins to heal and the pain decreases, more exercises can be gradually implemented until complete healing is achieved. During treatment, a follow-up visit is necessary, during which the orthopedist will order an X-ray to make sure the bone is healing in a good position.

Surgical treatment

When there is significant displacement of the fragments during a clavicle fracture, the orthopedist usually recommends surgery. The procedure is performed under full anesthesia and involves open setting of the fragments with their stabilization with plates and screws. Since the metal plates are attached to the outer surface of the bone, and the clavicle lies directly under the skin, they can be felt. Normally, plates and screws are not removed once bone fusion is complete, as long as they do not cause discomfort. Occasionally, patients may experience irritation of the operated clavicle area when using a seat belt in a car or wearing a backpack. If this is the case, the metal components can be removed after the fracture has healed. It is important to remember that a natural part of the postoperative healing process is to feel pain. Therefore, it can be somewhat alleviated with ice packs and the use of painkillers and anti-inflammatory drugs prescribed by the doctor. A significant advantage of surgical treatment over conservative treatment is the shorter period of immobilization of the limb and the possibility of movement in the shoulder even as early as a week after surgery.

After surgery, a period of rehabilitation begins. Specialized exercises will help restore mobility and avoid muscle weakness in the arm. It is important that rehabilitation is carried out under the guidance of a physiotherapist, who can additionally provide a plan for home therapy. Regardless of whether the broken collarbone required surgery or not, it may take several months to return to full function. In diabetics or smokers whose clavicle has been broken, treatment may take a little longer. The doctor decides when it will be possible to function normally again, based on follow-up examinations. Once the clavicle fracture has completely healed, a safe return to sports activities is as possible.

Learn about other possible shoulder injuries.

Bibliography:

Autor
RAFAŁ CZEPUŁKOWSKI
RAFAŁ CZEPUŁKOWSKI

Specjalista do spraw content marketingu, dziennikarz sportowy i medyczny. Redaktor naczelny magazynu „Poradnik Zdrowie i Sport”, członek Dziennikarskiego Klubu Promocji Zdrowia, współtwórca wielu artykułów medycznych z zakresu ortopedii i urazowości w sporcie.

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Konsultacja merytoryczna
MACIEJ PAWLAK
MACIEJ PAWLAK

Lekarz w klinice Rehasport, specjalizuje się w ortopedii i traumatologii narządu ruchu z ukierunkowaniem na staw kolanowy, biodrowy i barkowy. Międzynarodowy trener chirurgii barku i kolana prowadzący praktyczne kursy dla ortopedów zarówno w Polsce, jak i za granicą.

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