Clavicle Fracture – Causes, Symptoms and Treatment
A clavicle fracture is a break of the collarbone, one of the most common bone injuries. It typically results from falls or direct impact to the shoulder area.
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A clavicle fracture is a break of the collarbone, one of the most common bone injuries. It typically results from falls or direct impact to the shoulder area.
What is a Clavicle Fracture?
A clavicle fracture – also known as a broken collarbone – is a break of the clavicle, the long slender bone connecting the sternum (breastbone) to the scapula (shoulder blade). It is one of the most frequently fractured bones in the human body, accounting for approximately 5–10% of all fractures. Clavicle fractures can affect people of all ages, from newborns to elderly individuals.
Causes
Clavicle fractures most commonly result from falls onto an outstretched hand or directly onto the shoulder. Typical causes include:
- Sports injuries (e.g., cycling, horseback riding, contact sports)
- Traffic accidents
- Direct blows or impacts to the collarbone
- Birth trauma (in newborns during delivery)
In older adults, underlying conditions such as osteoporosis can weaken the bone, making fractures more likely even with minor trauma.
Classification
Clavicle fractures are classified according to the location of the break:
- Middle-third fractures (Group I): The most common type, accounting for approximately 70–80% of cases. The break occurs in the middle segment of the clavicle.
- Lateral fractures (Group II): Fractures of the outer third, near the shoulder joint, occurring in approximately 15–25% of cases.
- Medial fractures (Group III): Fractures of the inner third, near the breastbone. These are the rarest type, representing about 5% of clavicle fractures.
Symptoms
The symptoms of a clavicle fracture are usually clearly recognizable:
- Severe pain over the collarbone, worsening with movement
- Swelling and bruising (hematoma) over the fracture site
- Visible or palpable deformity – the broken bone may protrude visibly under the skin
- Restricted shoulder and arm movement
- A grinding or crackling sensation (crepitus) when moving the shoulder
- Protective posture, holding the affected arm close to the body
In rare cases, adjacent structures such as blood vessels, nerves (e.g., the brachial plexus), or the lung may also be injured.
Diagnosis
The diagnosis of a clavicle fracture is established through:
- Clinical examination: Visual inspection and palpation of the collarbone
- X-ray imaging: The standard method to confirm and localize the fracture
- Computed tomography (CT): Used for complex or joint-adjacent fractures and surgical planning
- Ultrasound: As a supplementary tool, particularly in children or to detect associated soft tissue injuries
Treatment
Conservative Treatment
The majority of clavicle fractures – especially uncomplicated middle-third fractures – can be managed non-operatively:
- Immobilization using a sling or a figure-of-eight bandage for 4–6 weeks
- Pain management with non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol
- Physiotherapy once acute pain subsides, to restore shoulder function and strength
Surgical Treatment
Surgical intervention is indicated in specific situations:
- Significantly displaced fractures
- Open fractures (bone penetrating the skin)
- Associated vascular or nerve injuries
- Fractures failing to heal with conservative management (nonunion)
- Certain lateral fractures with associated ligament injuries
Common surgical techniques include plate fixation (securing the bone with a metal plate and screws) and intramedullary nailing (inserting a nail into the bone canal).
Recovery and Prognosis
Healing typically takes 6–12 weeks in adults and somewhat less time in children. The prognosis for uncomplicated fractures is generally excellent. Potential complications include delayed healing, malunion (improper alignment), nonunion (failure to heal), and temporary or permanent reduction in shoulder function.
References
- Leitlinie der Deutschen Gesellschaft fuer Unfallchirurgie (DGU): Frakturen der Klavikula – AWMF registration no. 012-014 (2020).
- Brinker MR, O'Connor DP. The incidence of fractures and dislocations referred for orthopaedic services in a capitated population. J Bone Joint Surg Am. 2004;86(2):290-297.
- Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80(3):476-484.
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