Clavicle Fractures

A clavicle fracture, also called broken collarbone, is a common fracture that happens to people of all ages. The collarbone or clavicle is the bone that connects your sternum or breastbone to your shoulder. A broken collarbone normally occurs after a fall onto the shoulder or a motor vehicle accident. The most common sports associated with clavicle fractures include football, hockey, and skiing.

A broken collarbone most often causes pain, swelling and bruising over the collarbone. Pain increases with shoulder movement. Your shoulder may be slumped downward and forward. You may also have a bump around the area of the break. You may hear a grinding sound when you try to raise your arm.

To diagnose a broken collarbone, your doctor will take a brief history about the injury and perform a physical examination of your shoulder. An X-ray of the clavicle is taken to know the location and extent of the break. Your doctor may also recommend a computerized tomography (CT) scan if other bones are fractured.

Most broken collarbones can heal without surgery. To support the arm and hold the bones in their normal position you’ll likely need to wear an arm sling. You’ll be given pain medications to relieve the pain.  After your pain reduces your doctor may recommend gentle shoulder and elbow exercises to minimize stiffness and weakness in your shoulder. You will follow up with your doctor until your fracture heals.

Surgery may be required if the bone ends have shifted out of place (displaced). Surgery is performed to align the bone ends and hold them stable during healing to improve shoulder strength. Surgery often involves use of pins or plates and screws to maintain proper position of your bones during the healing process.

Plates and Screws fixation: In this procedure your surgeon will reposition the broken bone ends into normal position and then uses special screws or metal plates on the outer surface of the bone to hold the bone fragments in place. These plates and screws are usually left in the bone. If they cause any irritation, they can be removed after fracture healing is complete.

Pins: Placement of pins may also be considered to hold the fracture in position and the incision required is smaller than that needed for inserting plates and screws. Pins often cause irritation in the skin at the site of insertion and have to be removed once the fracture heals.

Patients with diabetes, elderly individuals and people who use tobacco products are at greater risk of developing complications both during and after the surgery. Specific risks of clavicle fracture surgery include difficulty in bone healing, lung injury and irritation caused by hardware.

Elastic intramedullary nailing of the clavicle is a newer and less invasive procedure with less complications. It is considered a safe method for fixation of displaced clavicle fractures in adolescents and athletes as it allows rapid healing and faster return to sports. The procedure is performed under fluoroscopic X-ray guidance providing real time images during the procedure. It involves a small 1 cm skin incision near the sternoclavicular joint. A hole is drilled in the anterior cortex after which an elastic nail is inserted into the medullary canal of the clavicle. Then the nail is passed on to reach the fracture site. A second operation to remove the nail will be performed after 2-3 months of healing.

Your may need to begin gentle motion exercises and gradually move to strengthening exercises as your fracture heals.

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