Clavicle Fractures
A broken collarbone is also known as a clavicle fracture. This is a very common fracture that occurs in people of all ages, often related to sporting activities such as skiing and cycling.
Clavicle Anatomy
The collarbone (clavicle) is located between the ribcage (sternum) and the shoulder blade (scapula). It is the only bone connecting the arm to the body! The clavicle lies above several important nerves and blood vessels. However, these vital structures are rarely injured when the clavicle breaks, even though the bone ends can shift when they are fractured.
Description of Clavicle
The clavicle is a long bone and most breaks occur in the middle of it. Occasionally, the bone will break where it attaches at the ribcage or near the shoulder blade.
Causes of a Clavicle Fracture
Clavicle fractures are often caused by a direct blow to the shoulder as can happen during a fall onto the shoulder or a collision. A fall onto an outstretched arm can also cause a clavicle fracture. In babies, these fractures can occur during the passage through the birth canal.
Symptoms of a Clavicle Fracture
Clavicle fractures can be very painful and may make it hard to move your arm. Additional symptoms include:
- 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 break.
- Bruising, swelling, and/or tenderness over the collarbone.
Treatment for a Clavicle Fracture
If the broken ends of the bones have not shifted out of place (or displaced) and line up correctly, your fracture may not need surgery. Broken collarbones can heal without surgery. Dr. Meininger can help you determine if your fracture is likely to heal successfully. In most cases a brief 3-4 week course of immobilization in a sling with Physical Therapy is successful.
Arm Support
Patients often prefer a simple arm sling for comfort after breaking the collarbone. Wearing a sling helps to support the weight of your arm and keep it in position while it heals.
Medication
Pain is common after clavicle fractures. In addition to rest, ice and immobilization, pain medications, including acetaminophen, can help relieve pain as the fracture heals.
Ice
Ice packs are helpful both after injury and after surgery. Ice helps to reduce pain, swelling, and inflammation. Generally, 20 minutes each hour is prescribed. Use caution to apply ice over a T-shirt or cotton washcloth to protect the skin from frostbite injury.
Physical Therapy
Immobilizing your arm in a sling may predispose you to stiffness and/or weakness. Once your collarbone begins to heal, your pain will decrease and motion supervised by a Physical Therapist will aid in your recovery. Dr. Meininger has designed a protocol for recovery after clavicle fractures (below). Early exercises will help prevent stiffness and weakness and advance to more strenuous exercises once the fracture is completely healed.
Doctor Follow-Up
Dr. Meininger will request frequent follow-up visits to evaluate your progress during recovery and your clavicle for healing. A physical examination and x-rays will help Dr. Meininger ensure the bone is healing in good position. After the bone has healed, you will be able to gradually return to your normal activities.
Complications
Broken collarbones with normal alignment generally heal without complication. Displaced or shattered fractures, where the broken bone ends are no longer in normal alignment, also have the potential to heal successfully without surgery. However, one in four of these displaced fractures may fail to heal altogether and these fractures may require a longer period of immobilization (ie: more time in a sling). Displaced fractures left to heal on their own without surgery will never return to normal alignment. These patients will always have a bump over the collarbone or a deformity for life. The abnormal position may cause some patients to have shoulder weakness or loss of endurance.
Surgical Treatment for a Clavicle Fracture
Dr. Meininger frequently recommends surgery for displaced fractures of the collarbone with abnormal alignment because of a high risk of weakness and low patient satisfaction with non-operative care. In Dr. Meininger’s practice, patients treated with surgery for fractures of the collarbone are among the most satisfied Orthopaedic patients. Patients have an immediately more stable fracture, earlier pain relief, less required time in a sling, and a quicker return to sports and activity. Studies have shown that displaced fractures treated with surgery have higher patient satisfaction, are more likely to heal in a normal anatomic alignment, more likely to result in normal strength and shoulder function after healing; and less likely to go onto nonunion (or fail to heal altogether).
Plates and Screws
Multiple options exist for clavicle fracture surgery including pins, rods, and plates & screws. Because of his vast experience with clavicle fractures, Dr. Meininger prefers plate and screw fixation for displaced clavicle fractures. Studies have shown a high rate of successful bone healing with a low risk of complication. Other devices, including pins and rods, may be more likely to fail or require additional surgery. During this operation, the bone fragments are first repositioned into their normal alignment and then held in place with a plate designed especially for the collarbone and several screws. The most common complications include decreased sensation on the chest below the incision and prominent hardware. Numbness goes away gradually with time; although in some cases it may persist. Hardware that is bothersome enough to require repeat surgery is rare. In Dr. Meininger’s Orthopaedic practice, roughly one in ten (1/10) of patients with clavicle plates requests they be removed with a second operation.
Rehabilitation
Specific exercises will help restore movement and strengthen your shoulder. Dr. Meininger recommends outpatient Physical Therapy after clavicle fracture surgery. Dr. Meininger’s advanced clavicle therapy program (bel0w) typically starts with gentle motion exercises and will gradually add strengthening exercises to your program as your fracture heals.
Outcome
Patients will clavicle fractures can expect improved symptoms, decreased pain, and a return to more activities within 3-4 weeks. Most patients with clavicle fractures feel 80% better within 1 month, and return to regular activities within 3 months of their injury. Your doctor will tell you when your injury is stable enough to do so. Whether your treatment involves surgery or not, it can take several months for your collarbone to heal by X-ray. Patients with diabetes and those that abuse tobacco may take even longer. Therefore it is important to avoid another injury during your recovery. Returning to regular activities or lifting with your arm before your doctor advises may cause your fracture fragments to move or your hardware to break –definitely something better off avoided! Once your fracture has completely healed, you can safely return to sports activities.
References:
1. Andersen, K et al. Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling. Acta Orthop Scand. 1987 Feb;58(1):71-4.
2. McKee, RC et al. Operative Versus Nonoperative Care of Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Clinical Trials.J Bone Joint Surg Am, 2012 Apr 18;94(8):675-684.
3. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89:1-10.
4. Millett, PJ: Complications of clavicle fractures treated with intramedullary fixation. J Shoulder Elbow Surg. 2011 Jan;20(1):86-91.
5. Wijdicks, FJ et al. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg. 2012 May;132(5):617-25.