What is a Broken Collarbone?
A broken collarbone–or fractured clavicle–is an injury to the front (anterior) bone of the shoulder complex. Clavicle fractures are common, accounting for 5% of all bone fractures. Most breaks occur in the middle section of the clavicle bone. Occasionally, a fracture can occur at the end of the clavicle, either at its outer end where it attaches to the scapula (shoulder blade) or to its inner end where it attaches to the breastbone. A fractured collarbone is painful and makes arm movement difficult.
The clavicle fracture can either be one simple fracture line separating the bone into two pieces or the clavicle can be fractured into many different pieces. The latter injury is referred to as a comminuted clavicle fracture. The fractured bone may be minimally displaced, where the bone ends are still lined up, or the fracture can be displaced, where the bone ends are severely separated from one another. Nondisplaced fractures will heal fairly predictably in 6-8 weeks. Conversely, displaced clavicle fractures may require surgical repair in order to align the bones properly and allow the fracture to heal properly. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopaedics and Neurosurgery. He is an expert at diagnosing and treating clavicle fractures for patients in Vail, Summit County, Aspen, and Denver, CO.
What Causes a Broken Clavicle?
Most fractured clavicles result from a hard fall or sudden impact to the shoulder. There is a higher incidence of clavicle fractures in sports such as snowboarding, skiing, mountain biking, and football. Motor vehicle accidents also often cause broken clavicles. People under the age of 20 and older females with osteoporosis are at higher risk for this injury, but people of any age can experience a broken clavicle. The clavicle is more susceptible to fracture as it is a long thin bone that helps connect the upper extremity to the chest wall.
What Does a Broken Collarbone Look Like?
After one fractures their clavicle, there is immediately a painful lump that is visible over the top of the clavicle. This outward bulge is often somewhat pointed–as the broken bone is lifting the soft tissue and skin away from its normal position. One may feel popping and cracking as well as increased pain with any movement of the arm. It is difficult to lay on one’s side and sleep. Several days after the injury, bruising often appears that tracks down the front of the chest.
How to Diagnose a Fractured Collarbone?
Most patients who sustain a clavicle fracture know that they have seriously injured their shoulder immediately after their injury. Symptoms include:
- Intense pain in the shoulder
- A visible outward bulge over the collarbone
- Increased pain with any shoulder or arm movement
- Tenderness over the area
- Grinding or cracking with shoulder movement
- Numbness or tingling in the arm
- Increased pain when coughing or deep breathing
If you experience these symptoms, urgent orthopedic evaluation is recommended. It is important to get an early and accurate diagnosis to ensure proper healing. Dr. Cunningham will take a complete medical history and conduct a physical exam. If a broken collarbone is suspected, xrays should be obtained to determine if there is a fracture. xrays at various angles will demonstrate whether the fracture is displaced and whether it is comminuted. An xray is critical to help determine the best treatment. If the fracture is significantly displaced, surgery may be recommended in order to allow for proper healing and a good outcome.
How Long for a Fractured Collarbone to Heal?
Most minimally displaced clavicle fractures do not require surgery and will usually heal in 6-8 weeks. Regaining full strength and function may take 3 – 4 months. Treatment of minimally displaced fractures consists of:
- Sling immobilization: Initially holding the arm in a sling helps decrease pain by preventing excessive shoulder range of motion and supporting the shoulder.
- Pain management: Acetaminophen (Tylenol) and icing the shoulder will help decrease pain. If required, stronger pain medications may be prescribed for a few days. NSAID’s such as ibuprofen should be avoided as these slow bone healing.
- Home exercises: Gentle range of motion of the hand, wrist, and elbow can be started immediately.
- Physical Therapy: Physical therapists may try taping techniques to help decrease pain as well as massage sore, injured muscles. Later, the PT will help you restore full shoulder range of motion and later strength. PT helps patients return to normal activities more quickly.
Does a Broken Clavicle Require Surgery?
Clavicle fractures are often significantly displaced, especially in athletic people who sustain a hard fall or impact to the shoulder. If the clavicle is fractured into numerous pieces that are significantly separated from one another, surgery is usually indicated. Without surgery, the bone fragments stand a higher likelihood of (1) not healing with bone and instead scar tissue joins the bone fragments together (nonunion) and this can cause continued pain, or (2) the bone fragments will heal in poor alignment, such as the the clavicle healing overlapped and shortened (malunion) which could compromise future shoulder biomechanics.
Clavicle fracture surgery consists of exposing the fractured clavicle through an longitudinal incision made over the top of the bone, properly aligning all of the fractured fragments, and then applying a metal plate that is pre-contoured to fit the natural curve of the clavicle, and securing the plate to the aligned bone with small screws that pass through both the plate and bone. Once the bone is aligned and stabilized by the hardware, patient’s often have much less pain, as the bone ends are not moving and scraping against each other as the arm moves. Moreover, the bone will heal in its normal anatomic shape, which allows for a return of normal shoulder mechanics and function. Finally, once the bone is stabilized, the recovery is faster and patients can return to activities sooner. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopaedics and Neurosurgery. He is an expert at diagnosing and treating clavicle fractures for patients in Vail, Summit County, Aspen, and Denver, CO.