Clavicle Fracture (Broken Collarbone)

A clavicle fracture is a fairly common shoulder injury that occurs in people of all age groups.

The clavicle is one of the main bones in the shoulder and it is commonly known as the collarbone. It is a long, S-shaped bone that serves as a strut between the sternum (breastbone) and the scapula (shoulder blade). It plays a vital role in stabilizing the shoulder, facilitating arm movement and protecting neurovascular structures (nerves and blood vessels) that pass from the neck to the arm.

Clavicle fractures can be open or closed, simple (non-comminuted) or complex (comminuted), displaced or non-displaced.

The majority of clavicle fractures (about 70-80%) occur in the middle-third (midshaft) of the bone. This area is the thinnest and weakest part of the clavicle.

Less frequently, the bone breaks near its attachments to the ribs or scapula (shoulder blade). These fractures are serious due to their impact on upper limb function.

The clavicle connects the chest to the shoulder. It articulates medially (inner end) with the sternum at the sternoclavicular joint and laterally (outer end) with the acromion of the scapula at the acromioclavicular joint. These joints are critical for shoulder movement and stability. The clavicle supports the upper limb and maintains the shoulder away from the thorax, which allows for maximum range of motion. It is connected to many blood vessels and nerves leading to the upper limb, as well as chest and neck muscles.

Due to its critical position, any direct force to the shoulder such as a fall directly onto the shoulder or an outstretched arm may cause a clavicle fracture.

The most common cause is falling onto the shoulder. This typically happens when a person falls directly onto the side of the shoulder, often from a standing height or while playing sports. The force from the fall pushes the shoulder inward toward the chest, causing the clavicle to fracture, usually at its midsection, which is its weakest point.

The direct blow during a fall onto an outstretched hand (or elbow) or a car or motorcycle accident is another major cause.

Less commonly, this injury occurs during sports activities. Young adults, especially males, are the most likely to suffer this injury.

The same injury mechanisms can also lead to acromioclavicular (AC) joint dislocation.

Clavicle fractures may be accompanied by other injuries like:

• Neurovascular injuries: Damage to nearby nerves (e.g., brachial plexus) or blood vessels.
• Rib fractures: Especially common in more severe impacts.
• Pulmonary contusions (lung bruising)or pneumothorax (collapsed lung): If rib fractures or direct trauma affects the chest.
• Other skeletal injuries: Involving the shoulder girdle or upper spine.

The most common symptoms of a clavicle fracture are the following:

1. Severe Pain

• Pain usually begins immediately after the fracture occurs.
• It worsens with movement of the arm or shoulder.
• The pain is often sharp and localized directly over the fracture site.

2. Loss of Function / Limited Mobility

• The patient typically holds the affected arm close to the body.
• Lifting or moving the arm is extremely painful or impossible.
• This loss of function helps distinguish fractures from minor shoulder injuries.

3. Deformity and Asymmetry

• A visible bump or bulge may form over the fracture site.
• The shoulder on the affected side might appear lower or “dropped.”
• In displaced fractures, bone fragments can shift, causing misalignment.

4. Swelling and Bruising

• Inflammation develops quickly around the site.
• Bruising (ecchymosis)and contusions may appear within hours or a day due to bleeding under the skin.
• A hematoma(collection of blood) may form, contributing to swelling.

5. Grinding or Popping Sensation (Crepitus)

• Movement of the shoulder or arm may produce a grating or grinding noisedue to bone fragments rubbing together.
• This is known as crepitusand is a sign of a possible displaced fracture.

6. Shortened Shoulder Appearance

• Due to the pull of muscles (like the sternocleidomastoid), the shoulder may appear shortened or pulled inward.
• This is more common in mid-shaft clavicle fractures, the most frequent type.

7. Tenderness

• The fracture site is highly tender to touch.
• Pressure or palpation over the clavicle usually causes significant discomfort.

A clavicle fracture is diagnosed through a medical history and a physical examination. The doctor will ask about how the injury happened—commonly from a fall on the shoulder, a direct blow (e.g., from sports or a car accident), or a fall onto an outstretched hand. It’s important to determine the force and direction of impact.

Through the physical examination, the doctor will look for the following:

• Swellingor bruising over the clavicle (collarbone).
• Tenderness on palpation(pressing on the bone causes pain).
• Obvious deformityor “step-off” in the bone’s shape.
• Arm position: Patients may cradle the arm or be unable to lift it.

The clinical presentation indicates the presence of the fracture, as the area above the clavicle shows significant swelling, and palpation is quite painful.

A clavicle fracture can be diagnosed based on symptoms like decreased limb mobility and visible bone deformity.

Initial diagnosis typically involves a plain X-ray, while CT scans are used for more detailed assessment in specific cases.

Clavicle fractures can be treated conservatively or surgically depending on fracture type and clinical presentation. Simple, non-displaced or minimally displaced fractures, without significant bone fragmentation (comminution), are often treated conservatively with immobilization and medication (NSAIDs or other analgesics). This approach aims to promote healing without surgery.  Physiotherapy is recommended to maintain movement and prevent shoulder stiffness. Surgery is indicated when:

• The fracture is severely displaced(bone ends do not align properly)
• There are multiple bone fragments(comminuted fracture)
• The skin is broken (open fracture)
• There’s risk to neurovascular structuresunderneath
• The fracture involves the distal clavicle(near the shoulder joint) with acromioclavicular (AC) joint involvement
• Multiple injuries(e.g. scapula, humerus, ribs) exist, requiring quick shoulder stabilization

One common surgical option is the Open Reduction and Internal Fixation (ORIF).  This surgical procedure involves realigning the bone and securing it with metal plates, screws, or rods. Internal osteosynthesis, often referred to as internal fixation, is a surgical procedure that aims to stabilize fractured bones, potentially improving functionality and reducing complications like pseudoarthrosis or malunion (healing in the wrong position, causing deformity or dysfunction).