Mountain biking season may be winding down, but ski and snowboarding season has already begun. Clavicle fractures often result from these high-energy activities. Most commonly, clavicle (collarbone) fractures are a result of a direct blow to the shoulder. Frequently, a fall over the handlebars of a bike or catching an edge on a snowboard and landing on the shoulder is the cause of these injuries. Clavicle fractures are one of the most commonly fractured bones.
The clavicle is an S-shaped bone that often breaks in the middle 1/3 of the bone. Fortunately, this predictable nature of fracture pattern makes treatment pretty straightforward. The first step if someone believes they may have injured their clavicle would be to seek medical attention by an orthopedic physician, urgent care, or emergency department. X-rays are then usually obtained to visualize the integrity of the bone. At that point, an orthopedic physician makes the determination if the fracture can be treated conservatively, without surgery, or if surgical intervention is advised.
Fractures that are minimally displaced can be treated without surgery. The patient is usually constricted to a sling for a period of time, usually 6 weeks, to allow the bone to heal. Fracture healing will be followed by an orthopedic physician to assure bone bridging and healing. If surgery is advised, this usually entails fixation of the fracture with hardware. Most commonly, the repair requires a plate and screws to hold the broken clavicle bones together so that they heal perfectly aligned. The surgical hardware may remain in place forever, or it can be removed after complete healing has occurred. Following surgery, the patient will also be confined to sling for a time to allow healing to occur without stress to the bone fragments. X-rays will be taken at follow-up appointments to evaluate bone healing.
Some fractured clavicles do not heal and go onto what is called a nonunion. The risks of a nonunion are higher for displaced, multi-piece fractures that are treated without surgery. Occasionally, fractures treated with surgery fail to heal but this is quite rare. There are certain risk factors for not healing a fracture such as smoking, diabetes and some medications for autoimmune disorders.
Long term, patients with clavicle fractures treated by orthopedists usually do very well. Once healing from this type of fracture occurs, patients are able to return back to their normal activities and sports.
Authors: Dr. Richard Cunnningham, M.D. and Gretchen Meador, PA-C.