by Robert J. Snyder, MD
The clavicle, or better known as the collarbone, is a vulnerable site for fracture in the body. To go over the anatomical background, the clavicle connects the arm to the body, and is located between the ribcage and the shoulder blade. The clavicle is vulnerable to damage because of its anterior location in the body and thin middle shaft. The middle segment has little muscle and ligament support to defend against any blows to the arms and shoulders that could potentially crack the bone. Fractures of the clavicle are most common in children and young adults, because the clavicle doesn’t completely harden until around age 20.
There are three types of clavicle fractures:
• Midshaft: This is the most common type of clavicle fracture which occurs in the middle of the collarbone. The diagnosis for this type of fracture is fairly straightforward and often times will heal without surgical treatment.
• Distal: These occur less often than midshaft fractures, and are usually located near the coracoclavicular ligaments, closer to the shoulder on the clavicle.
• Proximal: We do not see many patients with proximal collarbone fractures. These fractures occur in the segment of the clavicle closest to the sternum.
How is a clavicle fracture caused?
The most common cause of this type of fracture is a fall on the shoulder with the arm at the side. Falling onto an outstretched arm can also cause damage. Contact sports such as football often can cause collarbone fractures because of the weight of the opponent driving against or landing on top of a person. Think of all the NFL quarterbacks who have been out of action 4-8 weeks because of a fractured clavicle. In cycling clavicle fractures occur when a rider during a crash is thrown over the handlebars. In some cases, a newborn can fracture their clavicle during the birthing process.
What are the symptoms?
• Bump over the area fractured
• Inability to lift arm
• Slumped shoulder
• Snapping sound when moving the shoulder
How is a fracture diagnosed and treated?
An initial diagnosis will consist of physically checking the area for symptoms of a fracture. An x-ray will determine the exact location and extent of the fracture. Most fractures can be treated conservatively. Immobilization of the collarbone is essential in allowing it to heal, so I will have most patients wear a sling. Over-the-counter medications can be used to reduce pain and inflammation. While your arm is in a sling, the body can lose muscle strength from the restriction. It is important to minimize stiffness in the arms and shoulder during rehabilitation, so gentle home exercises and physical therapy can be implemented.
If the bones are completely significantly displaced or angulated there are surgical options to consider for a fractured collarbone. Surgery can re-align the bones and hold in them in place until they are fully healed. During the procedure, the bones are positioned correctly, and then held in place with metal plates and screws. Physical therapy can be used in recovering the strength and mobility of the shoulder after surgery. A few of the risks associated with this type of surgery are issues with the bone healing (non-union), hardware irritation, and infection. Most clavicle fractures take around three months to fully heal.