Broken Collarbone (Clavicle Fracture)

Anatomy
The collarbone (clavicle) is considered part of the shoulder. It helps connect the arm to the body. The collarbone lies above several important nerves and blood vessels. These vital structures are rarely injured when the collarbone breaks. The collarbone is a long bone, and most breaks occur in the middle section.

Cause
A broken collarbone (clavicle fracture) is a common injury among children and athletes.

Because the collarbone doesn't completely harden until a person is about 20 years old, a child's collarbone can easily break from a direct blow or fall.

In athletes, the force of a fall can be transmitted from the elbow and shoulder to the collarbone, causing it to break.

Symptoms

• Sagging shoulder (down and forward)
• Inability to lift the arm because of pain
• A grinding sensation if an attempt is made to raise the arm
• A deformity or "bump" over the fracture site

Diagnosis
There is usually an obvious deformity, or "bump," at the fracture site. Gentle pressure over the fracture site will bring about pain. Sometimes, a grinding feeling can be felt when the patient tries to raise the arm. Although a fragment of bone rarely breaks through the skin, it may push the skin into a "tent" formation. Your orthopedic doctor will carefully examine the shoulder to make sure that no nerves or blood vessels were damaged. An X-ray is often done to pinpoint the location and severity of the break.

Nonsurgical Treatment
Most broken collarbones heal well without surgery.

A simple arm sling can usually be used to immobilize the arm. A child may have to wear the sling for 3 to 4 weeks; an adult may have to wear it for 6 to 8 weeks.

Analgesics such as acetaminophen or nonsteroidal anti-inflammatory medications, such as aspirin or ibuprofen, will help reduce pain.

A large bump will develop as part of the healing process. This usually disappears over time, but a small bump may remain.

After the bone has healed normally, shoulder function generally returns with time. The result is little, if any limitation, unless the fracture was widely displaced (the parts of the broken bones are separated a lot. Range of motion and strengthening exercises can begin as soon as the pain subsides. Sports activities should not be started until full shoulder strength returns.

Surgery
Although many clavicle fractures heal uneventfully without shoulder surgery, there are certain indications when a clavicle fracture should be treated with surgery:

• Significant fracture displacement
• Significant shoulder deformity
• Compromise to the skin near the fracture
• Non-union – when a fracture previously treated without surgery fails to heal on its own
• Mal-union – when a previously treated fracture heals in a bad position
• Recent orthopedic literature suggests that surgical correction of a broken collarbone (clavicle fracture) may be beneficial compared to non-surgical management in young, active athletes or patients who perform overhead manual labor. Studies have shown improved outcomes with respect to strength in this population when surgery was performed.

Dr. Samimi is a Southern California orthopedic surgeon offering broken collarbone treatment at 3 location in West Covina, Encino and Brentwood / West LA.