The clavicle (also known as a collarbone) acts as a splint, connecting the shoulder to the sternum (breastbone). It has muscles attached to it, and also helps to protect some of the large blood vessels / nerves that travel underneath it to the arm.

Causes

A broken clavicle is a very common injury, and usually results from a fall. It can happen from any fall, but is frequently seen during certain sports such as AFL or soccer, or occasionally after road traffic accidents.

Symptoms

A broken collarbone causes pain, swelling and bruising over the collarbone. It hurts to move the arm, and the shoulder may feel as if it is slumped forwards or down. Sometimes a bony lump can be seen over the fracture site.

Diagnosis

To diagnose a broken collarbone, your doctor will ask you questions about how you injured the area, and will examine your shoulder. Simple x-rays will almost always show this fracture, but at times a CT scan may help as well.

Treatment

The majority of clavicle fractures that occur are in children, when nearly all the time a sling is used for a short period, and healing can be expected. Return to normal function is usually rapid.

In adults however the situation is different. Although this injury will normally heal without surgery, if the bone ends are not aligned well (particularly if they are overlapped, which means the bone will heal shorter than before, or if they are far apart) then surgery may be recommended.

Management without surgery typically means wearing a sling to support the arm, which will make it more comfortable. Once the pain settles (typically 2-4 weeks) then exercises can be started, often with the guidance of a physiotherapist. It is important not to let the shoulder get stiff in this time, and so some movements should be started as soon as pain allows.

Surgery

If surgery is required, then the aim of this is to replace the bone ends back to their original position, and hold them there with a plate and screws. This is done under a general anaesthetic, and often as a day case procedure. One advantage of surgery is that mobility of the shoulder and arm can usually be started almost immediately after surgery, and so return to function is typically quicker than non-operative treatment. The plates and screws are generally left in permanently, unless they cause irritation. This can happen, especially in thin patients, as the clavicle is just under the skin and so the screws can sometimes be tender or rub on clothes. If they need to be removed, this is a simple day case procedure that can be done at any time after 6 months.

Rehabilitation / return to function

Whether treated surgically or not, this injury typically has a very good outlook. Most people are back to normal daily activities by 6 weeks, and return to sport can be from 8 weeks onwards. Complications are uncommon and rarely serious. Perhaps the most common problem after a broken clavicle is shoulder stiffness, which can usually be avoided with exercises once pain allows.

Clavicle fracture X-ray

Clavicle fracture – plate and screws