What are clavicle fractures?
A clavicle fracture, commonly known as a broken collarbone, is a frequent injury involving the bone that connects the shoulder to the breastbone. The clavicle plays an important role in shoulder movement, stability, and overall upper limb function. Clavicle fractures can occur at any age but are particularly common in children, young adults, and athletes. Most fractures occur in the middle portion of the bone and can range from simple cracks to displaced fractures where the bone ends have shifted apart. While many clavicle fractures heal well without surgery, some injuries may require operative treatment to restore alignment and shoulder function.
Causes
Clavicle fractures most commonly occur following a fall onto the shoulder, an outstretched hand, or direct trauma to the collarbone. Sporting injuries, cycling accidents, contact sports, and motor vehicle accidents are frequent causes. In younger patients, high-energy sporting injuries are common, while in older adults, falls from standing height may result in fracture due to reduced bone strength. The severity and pattern of the fracture depend on the amount and direction of force applied to the shoulder.
Symptoms
Sudden pain over the collarbone following injury
Swelling, bruising, and tenderness around the fracture site
A visible bump or deformity over the clavicle
Difficulty lifting or moving the arm because of pain
The shoulder may appear to droop downward
Grinding sensations or abnormal movement at the fracture site in more severe injuries
Rarely, associated nerve, blood vessel, or lung injuries may occur with high-energy trauma
Diagnosis
Diagnosis is made through a combination of clinical examination and imaging studies. During examination, the clinician will assess the area for swelling, deformity, tenderness, skin integrity, and shoulder movement. The arm and shoulder are also examined to ensure there is no associated nerve or vascular injury. In some cases, fractures may place pressure on the skin or involve surrounding joints, which can influence treatment decisions. A detailed assessment helps determine the severity and stability of the fracture.
Imaging
X-rays are the primary imaging study used to diagnose clavicle fractures and assess the position and alignment of the bone fragments. Standard shoulder or clavicle X-rays are usually sufficient to identify the location and severity of the fracture. In more complex injuries, CT scans may be required to provide detailed assessment of fractures extending into the joints or involving significant displacement. Imaging also helps monitor healing during recovery and guides decisions regarding surgical or non-surgical treatment.
Treatment
Conservative (Non-Operative)
Most clavicle fractures can be treated successfully without surgery. Conservative treatment typically involves wearing a sling for comfort and support while the fracture heals naturally. Pain relief medication, ice, and activity modification are commonly recommended in the early stages. Gentle shoulder movement exercises are gradually introduced to prevent stiffness, followed by strengthening exercises as healing progresses. Most patients regain good shoulder function over time, although healing may take several weeks to months depending on the severity of the fracture and the patient’s age and activity level.
Surgical treatment
Surgical treatment may be recommended for significantly displaced fractures, fractures with shortening of the clavicle, open fractures, skin compromise, associated nerve or vascular injury, or fractures that fail to heal properly. Surgery usually involves repositioning the bone fragments and securing them with plates and screws or, less commonly, intramedullary fixation devices. The goal of surgery is to restore normal alignment, improve healing, and allow earlier return of shoulder function. Following surgery, patients undergo a structured rehabilitation programme to gradually restore movement, strength, and function of the shoulder.
Recovery
When can I return to daily activities?
This depends on the range of movement and strength that you have in your shoulder following the operation. Please discuss activities in which you may be interested with your physiotherapist or surgeon. Start with short sessions, involving little effort and gradually increase.
Examples are :
- Return to office or light duties (no use of the arm at chest height or above, no repetitive duties, no heavy lifting) at 10-14 days. Sling should be worn when using a computer / doing admin work
- Walking for exercise from 2 weeks
- Driving – approximately 4-6 weeks, 15-30 minutes as you feel safe and confident. When you are no longer using the sling and have full control of the vehicle. No truck driving until 4 months
When can I participate in leisure activities?
This depends on the range of movement and strength that you have in your shoulder following the operation. Please discuss activities in which you may be interested with your physiotherapist or surgeon. Start with short sessions, involving little effort and gradually increase.
Examples are:
- Cycling – 4 to 6 weeks
- Jogging – 8 – 12 weeks
- Swimming – gentle breast-stroke 12 weeks, freestyle variable timeframe (minimum 4 months)
- Light sports/racquet sports using non-operated arm – 10 weeks
- Racquet sports using operated arm– 4 months
- Golf – 3 – 6 months Contact or collision sports which includes horse