Clavicle (collar bone) fracture | NHS inform

Your injury may be referred to as a fracture, break or crack. These terms all mean the same thing.

When you have a fracture, it’s not just the bone that’s affected. You’ll also have injured some of the soft tissues around it. Soft tissues include the:

• muscles
• ligaments
• tendons
• nerves

A clavicle (collar bone) fracture.

Recovery times

A clavicle fracture can take between 6 to 12 weeks to heal.

It’s normal to have aches and discomfort beyond this. It’s also common for the area to be more sensitive for several months afterwards.

What can affect your recovery?

There are some things that might affect your recovery.

Smoking

Smoking affects all your tissues and slows facture healing times. In some people, it can stop healing altogether.

Stopping smoking as your fracture heals will help to ensure the best recovery.

Get help to stop smoking.

General health

Some medical conditions, like diabetes, may slow down the healing process.

Eating a healthy diet and keeping yourself active will help your recovery.

Medication

Some medications can slow down fracture healing. If you have concerns about your medication talk to a healthcare professional.

Anti-inflammatory medication, like Ibuprofen or Naproxen, have been shown to delay healing.

What to expect after a clavicle fracture

It’s common for a lump to form around the injured area at your collar bone as the healing takes place. In many cases this will remain after your clavicle has healed. You don’t need to seek help for this unless there is a change to the lump.

Following your X-ray and diagnosis, your fracture will be managed in a Poly Sling.

How to fit a Poly Sling
(https://www.youtube.com/watch?v=3ZFnoKjw_Zs)

Rehabilitation plan

There are things you can do to help your recovery after a clavicle fracture.

0 to 3 weeks after your injury

Just after your injury, you should:

• wear sling during the day except for exercises and personal hygiene
• choose whether to wear your sling at night
• start some exercises for your shoulder
• avoid lifting your elbow above shoulder height as this may be painful

3 to 6 weeks after your injury

Between 3 to 6 weeks after your injury, you should:

• try not to use your sling
• begin normal light activities with your arm and shoulder
• increase movement
• avoid heavy lifting

6 to 12 weeks after your injury

The injury should be healed between 6 to 12 weeks but heavy tasks may cause discomfort.

You should aim to:

• resume normal day to day activities but be guided by any pain that you experience – stop if movements become painful
• start to lift your arm overhead
• avoid contact sport until at least 12 weeks after the injury

Help and support

If your collar bone hasn’t improved within 6 weeks of following this advice, it’s a good idea to talk to a healthcare professional about your symptoms.

Swelling

It’s normal to have swelling near the fracture site. It often spreads down your arm.

Swelling can sometimes last for months. The amount of swelling can also change depending on:

• your position
• your activity
• the time of day

It’s important that swelling is managed well to help your recovery.

How to reduce swelling

To help reduce the swelling you should:

• keep the other joints in your arm moving normally
• find a balance between rest and activity
• Use self massage to reduce swelling – gently use your fingertips to push the fluid towards your shoulder

Bruising

It’s normal to have bruising after a fracture.

Bruising can be widespread and may appear a long way from your fracture. It can be very purple to start with and may change colour as you recover.

Pain after a fracture

It’s normal to have some discomfort in the areas around your fracture. The areas affected can be:

• other soft tissues
• nearby joints
• areas that have been immobilised

Pain can change from day to day and it doesn’t always depend on what you’re doing. It’s common to have pain at rest.

It’s normal to have some pain even when your fracture has healed. Some people also experience discomfort in the fracture site during colder weather.

Your local pharmacy can give you advice on managing pain after a fracture.

Find your local pharmacy

Use Scotland’s Service Directory to find your local pharmacy.

Pharmacies

Getting back to normal activities

There are some things you should consider when trying to get back to your normal activities.

Driving

You should contact your insurance provider before driving. Your injury may affect your insurance.

Once you’re out of your sling, you must be able to safely perform an emergency stop or manoeuvre.

You should always be in full control of your vehicle.

Work

Your return to work will depend on the type of work you do and your employer. It may be possible to discuss a phased return to work or changed duties.

You don’t need to see a healthcare professional to return to work.

Daily activities

Keep doing any activities you’re able to, and as your pain allows. Gradually increase what you do.

Reduced flexibility and strength may make things more difficult to start with. This will get better as you slowly build up to all your usual activities.

Mood

Frustration or low mood after an injury is normal. As you get back to normal life this should get better.

Falls

Loss of confidence is common after a fracture.

Get advice about preventing falls.

Bone scanning

You may be sent a letter inviting you for a scan of your bone density after a fracture.

It’s routine to be assessed for any further risk of fracture, especially if you:

• are over the age of 50
• have increased risk factors for fracture

Exercises for your shoulder

You can practice exercises for your injured shoulder.

You should aim to do these exercises 4 to 5 times a day.

Stop these movements if they make your symptoms worse, or cause new pain.

Source:
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Last updated:


16 December 2022

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Clavicle Fracture (Broken Collarbone) – OrthoInfo

A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. This type of fracture is fairly common, accounting for about 5% of all adult fractures.

Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it snaps or breaks. A broken collarbone can be very painful and can make it hard to move your arm.

Many clavicle fractures can be treated by wearing a sling to keep the arm and shoulder from moving while the bone heals. With some clavicle fractures, however, the pieces of bone move far out of place when the injury occurs. For these more complicated fractures, surgery may be needed to realign the collarbone.

The clavicle is located between the ribcage (sternum) and the shoulder blade (scapula). It is the bone that connects the arm to the body.

The clavicle lies above several important nerves and blood vessels. However, these vital structures are rarely injured when a fracture occurs.

The clavicle is part of your shoulder and connects your arm to the rest of your body.

Reproduced and adapted from JF Sarwak, ed: Essentials of Musculoskeletal Care, ed. 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Clavicle fractures are fairly common and occur in people of all ages. Most fractures occur in the middle portion, or shaft, of the bone. Occasionally, the bone will break where it attaches at the ribcage or shoulder blade.

Clavicle fractures vary. The bone can crack just slightly or break into many pieces (comminuted fracture). The broken pieces of bone may line up straight or may be far out of place (displaced fracture).

This illustration shows a clavicle fracture close to where the bone attaches to the scapula (shoulder blade).

Reproduced and adapted from Nuber GW, Bowen MK: Acromioclavicular joint injuries and distal clavicle fractures. J Am Acad Orthop Surg 1997; 5(1): 11-18.

Clavicle fractures are most often caused by a direct blow to the shoulder. This can happen during a fall onto the shoulder or an accident, like a car collision. A fall onto an outstretched arm can also cause a clavicle fracture. In a baby, a clavicle fracture can occur during the passage through the birth canal.

A clavicle fracture can be very painful and may make it hard to move your arm. Other signs and symptoms of a fracture may include:

• Sagging of the shoulder downward and forward
• Inability to lift the arm because of pain
• A grinding sensation when you try to raise the arm
• A deformity or bump over the break
• Bruising, swelling, and/or tenderness over the collarbone

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Physical Examination

Your doctor will want to know how the injury occurred and will ask about your symptoms. They will then carefully examine your shoulder.

In a clavicle fracture, there is usually an obvious deformity, or bump, at the fracture site. Gentle pressure over the break will bring about pain. Although it is rare for a bone fragment to break through the skin, it may push the skin into a tent formation.

In a clavicle fracture, the broken ends of the bone may cause tenting of the skin over the fracture site.

Your doctor will also perform tests to ensure that no nerves or blood vessels were damaged when the fracture occurred.

Imaging Studies

X-rays. X-rays provide images of dense structures, such as bone. Your doctor will order an X-ray:

• To help pinpoint the location of the fracture
• To learn more about the severity of the break

The doctor may also order X-rays of your entire shoulder to check for additional injuries.

If other bones are broken, your doctor may order a computerized tomography (CT) scan to see the fractures in better detail.

X-ray shows a fracture in the middle of the clavicle. Note how far out of place (displaced) the broken ends of the bone are.

Nonsurgical Treatment

If the broken ends of the bones have not significantly shifted out of place, you may not need surgery. Many broken collarbones can heal without surgery.

Nonsurgical treatment may include:

• Arm support. A simple arm sling is usually used for comfort immediately after the break and to keep your arm and shoulder in position while the injury heals.
• Medication. Pain medication, including acetaminophen, can help relieve pain as the fracture heals.
• Physical therapy. Although there will be some pain, it is important to maintain arm motion to prevent shoulder and elbow stiffness. Often, patients will begin doing exercises for elbow motion immediately after the injury.

  After a clavicle fracture, it is common to lose some shoulder and arm strength. Once the bone begins to heal, your pain will decrease and your doctor may start gentle shoulder exercises. These exercises will help prevent stiffness and weakness. You will start more strenuous exercises gradually once the fracture is completely healed.

Follow-up care. You will need to see your doctor regularly until your fracture heals. During these visits, the doctor will take X-rays to make sure the bone is healing in a good position. After the bone has healed, you will be able to gradually return to your normal activities.

Complications. In some cases, a clavicle fracture can move out of place before it heals. It is important to follow up with your doctor as scheduled to make sure the bone stays in position.

If the fracture does not heal, it is called a nonunion.

• In some cases of nonunion, the patient has very little pain and good motion, so no further treatment is required.
• In other cases, nonunion can result in significant pain and may require an operation for repair. 

If the fracture fragments do move out of place and the bones heal in that position, it is called a malunion. Surgical treatment for this is very rare, determined by how far out of place the bones are and how much this affects your arm movement.

A large bump over the fracture site may develop as the fracture heals. This usually gets smaller over time, but a small bump often remains permanently.

Surgical Treatment

If the broken ends of the bones have significantly shifted out of place, your doctor may recommend surgery.

Surgery typically involves putting the broken pieces of bone back into position and preventing them from moving out of place until they are healed. This can improve shoulder strength when you have recovered.

Open reduction and internal fixation. This is the procedure most often used to treat clavicle fractures. During the procedure, the bone fragments are first repositioned (reduced) into their normal alignment. The pieces of bone are then held in place with special metal hardware.

Common methods of internal fixation include:

• Plates and screws. After being repositioned into their normal alignment, the bone fragments are held in place with special screws and metal plates attached to the outer surface of the bone.

  After surgery, you may notice a small patch of numb skin below the incision. This numbness will become less noticeable with time. Because the clavicle lies directly under the skin, you may be able to feel the plate through your skin.

  Plates and screws are not routinely removed after the bone has healed, unless they are causing discomfort. Problems with the hardware are not common, but some patients find that seatbelts and backpacks can irritate the collarbone area. If this happens, the hardware can be removed after the fracture has healed.

(Left) X-ray shows a displaced clavicle fracture (arrow). (Right) The pieces of bone have been realigned and held in place with plates and screws.

(Left) X-ray shows a severely displaced clavicle fracture (arrow). (Right) Here, a single screw has been used to repair the fracture.

Reproduced from Eichinger JK, Balog TP, Grassbaugh JA: Intramedullary fixation of clavicle fractures: anatomy, indications, advantages, and disadvantages. J Am Acad Orthop Surg 2016; 24(7): 455-464.

Pain management. After surgery, you will feel some pain.This is a natural part of the healing process. Many patients find that using ice and non-prescription pain medications are sufficient to relieve pain.

If your pain is severe, your doctor may suggest a prescription-strength medication, such as an opioid, for a few days.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose have become critical public health issues. For this reason, opioids are typically prescribed for a short period of time. It is important to use opioids only as directed by your doctor and to stop taking them as soon as your pain begins to improve.

Rehabilitation. Specific exercises will help restore movement and strengthen your shoulder. Your doctor may provide you with a home therapy plan or suggest that you work with a physical therapist.

Therapy programs typically start with gentle motion exercises. Your doctor will gradually add strengthening exercises to your program as your fracture heals.

Although it is a slow process, following your physical therapy plan is an important factor in returning to all the activities you enjoy.

Complications. There are risks associated with any type of surgery. These include:

• Infection
• Bleeding
• Problems with wound healing
• Pain
• Blood clots
• Damage to blood vessels or nerves
• Reaction to anesthesia

Risks that are specific to surgery for clavicle fractures include:

• Difficulty with bone healing
• Lung injury
• Numbness below the clavicle
• Hardware irritation

Patients who smoke or use tobacco products, have diabetes, or are elderly are at a higher risk for complications both during and after surgery. They are also more likely to have problems with wound and bone healing.

Learn more: Smoking and Musculoskeletal Health

Learn more: Surgery and Smoking

Before your surgery, your doctor will discuss each of the risks with you and will take specific measures to avoid complications.

Whether or not your treatment involves surgery, it can take several months for your collarbone to heal. Healing may take longer in diabetics or in people who smoke or use tobacco products.

Most people return to their regular activities within 3 months of their injury. Your doctor will tell you when your injury is stable enough to do so. Returning to regular activities or lifting with your arm before your doctor advises may cause the fracture fragments to move or the hardware to break. This may require you to start your treatment from the beginning.

Once your fracture has completely healed, you can safely return to sports activities.

Questions to Ask Your Doctor

If you experience a clavicle fracture, here are some questions you may wish to ask your doctor:

• When can I start using my arm?
• When can I return to work?
• Do I have any specific risks for not doing well?
• If I have to have surgery, what are the risks and benefits, and will I need to stay in the hospital?
• What are the risks and benefits of nonsurgical treatment?

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Fracture of the collarbone – treatment and rehabilitation in the Ilyinsky hospital.

Clavicle fractures – common
snowboarder injury. Also, this fracture occurs in cyclists, a little
less often for skiers. In everyday life, this fracture can also occur and is often associated
with high energy trauma. In general, clavicle fractures account for up to 6% of all
bone fractures. And in 4 out of 5 cases, this is a fracture of the body of the clavicle, i.e.
middle third of the bone.

Main threat when
a clavicle fracture is either a fusion in the wrong position, or
false joint formation. At the same time, fusion in the wrong position is not at all
no better than a false joint. Fragments are displaced, going behind each other. Bone
shortens, the points of muscle attachment approach. Normally, the muscle is stretched, and
if the fixation points are close, the muscle “sags”. Muscle tissue is regenerated
replaced by connective tissue. When the collarbone is shortened by 1 cm or more, it is lost
up to a third of the strength of the muscles of the shoulder girdle.

• The evolution of methods
  treatment of a clavicle fracture

that in 99% of cases, clavicle fractures should be treated conservatively. However, in
Recently, this view has been revised. It is associated with several
moments. On the one hand, patients have become more demanding of the quality
life after fracture treatment, and to the cosmetic effect after surgery. Second
moment: a conventional radiograph of the clavicle gave only one projection, and a computer
tomography allowed to look behind the bone and examine it from all sides. It is the ubiquitous
The use of computed tomography has made it possible to identify a large number of
nonunions in those cases that at the end of the last century would have been considered quite
satisfactory due to the lack of CT data.

In 2007, the Canadian orthopedic community, focusing on
on the scale of functions and pain of the shoulder joint after fractures of the clavicle, conducted
study. It has been shown that after surgical treatment, the function
recover faster and more stable than after conservative treatment. But completely
to exclude conservative non-surgical treatment of clavicle fractures is still not
costs. There are a number of patients whose clavicle fracture can be successfully treated without
surgical intervention – in particular, young patients with minor
offset.

On the other hand, if the patient is middle or older
age, and he had a primary displacement of 1 – 1.5 cm and even more, then in this
case, as a result of conservative treatment, we are likely to get
nonunion. Also, the choice of the optimal method of treatment is influenced by the age of the patient,
physical activity that was before the injury, profession, expectations of the patient,
the speed of rehabilitation that the patient plans, etc. All this is discussed in
direct conversation between the patient and the doctor.

• Conservative
  treatment

A conservative method is offered to young patients with
slight displacement, when the soft tissue sheath is not torn and is able to hold
bone fragments. With conservative treatment for a period of about 6 weeks
a soft eight-shaped bandage is applied, which fixes the patient in
the position of the straightened clavicles and shoulder girdle. Both halves of the body are fixed, the hand
suspended from the side of the fracture. The figure-of-eight bandage is not rigid, strongly
mobility is not limited. The patient must come for follow-up visits.
behind the process of accretion and expansion of motor activity. With conservative
treatment, you have to visit a doctor and perform x-rays much more often than
in surgical treatment.

• Minimally invasive
  surgery

an informed person will call an intraosseous nail. However, it is not always possible
perform intraosseous osteosynthesis with a nail. This technology has been popular
now its popularity is on the decline due to the unpredictability of the results. Orthopedists-traumatologists
Ilyinsky hospital prefers minimally invasive fracture treatment technologies
clavicle and perform osteosynthesis of the clavicle with a plate, introducing it through point
skin punctures. This high-tech X-ray-assisted operation allows
achieve a good cosmetic effect and good internal elasticity
fixation.

There is another important point. The point is that with the standard
approach, the surgical approach passes over two or three, depending on
individual anatomy of the patient, branches of the important supraclavicular nerve.
Innervation in this zone does not affect function, but does affect sensation.
the upper half of the chest, and in women also on the sensitivity of the breast
glands and nipple areas. After standard access, even if the nerve branches were protected
surgeon, three out of five women experience reduced sensitivity in this important area,
and many women do not. Use of less invasive approaches
excludes contact with the branches of this nerve, and in our patients, along with a fast
rehabilitation and rapid fusion of clavicle fractures is also fully preserved
sensitivity. Minimally invasive access to the clavicle to avoid
contact with the branches of the supraclavicular nerve, was developed and patented by the group
Russian traumatologists under the guidance of Andrey Volna. Currently
Andrey Anatolyevich Volna is the head of the Department of Traumatology, Orthopedics and
spinal surgery at the Ilyinsky hospital.

Collarbone surgery performed under general anesthesia. In
The patient is asleep during the operation. We seat – we seat, but do not lay!
– the patient on the operating table in the “beach chair position”, the so-called
beach
chair position.
The patient is reclining, reclining, as in a deck chair. This position allows
to achieve the most correct comparison of fragments of the clavicle without incision. Operation
is carried out under the control of a special X-ray machine (C-arm). Manipulating the broken pieces through
small incisions and punctures in safe areas, surgeons give them the correct
position. A metal plate is inserted into the incisions and fixed with screws.
A year later, the patient discusses whether the plate should be removed or left. Cosmetic
the consequences of the operation are minimal – two small vertical scars.

The operation is usually performed on the day of admission. On
the next day – dressing, the hand can be located on the scarf in a comfortable
position. The hospital stay lasts 1-2 days.

• Rehabilitation

Surgical treatment of clavicle fracture – practically
painless and comfortable for the patient method of treatment. Functions after it
recover quickly. And if in the case of conservative treatment of a fracture
clavicle, we stimulate physiotherapy exercises, then in the case
surgical treatment, on the contrary, we often even limit the physical
patient activity. Since there is no pain, then any person tries
recover faster … For competent and timely recovery in
Ilyinsky hospital rehabilitation of patients after a fracture of the collarbone is under control
experienced rehabilitators.

• Help for patients with
  false joint – reconstructive surgery

One of the important areas of work of the Department of Traumatology,
orthopedics and spinal surgery of the Ilyinsky hospital is assistance to patients with
false joints. Including after fractures of the clavicle. Such patients
come to us from different parts of the country. In this case, talk about
Unfortunately, minimally invasive surgery is no longer necessary. If a clavicle fracture
was treated incorrectly, then we are left with one path – bone transplantation and
osteosynthesis. AT 90% of cases bone fragment for transplantation is taken from a comb
patient’s iliac bone. And it all depends on what kind of false
the joint is formed. There are difficult cases with a defect after suppuration, then the graft
must be placed in a single block. And sometimes quite a bit is enough.
a fragment of the transplanted bone, only to “refresh” the area of ​​the false joint. This
high level reconstructive surgery.

• Consultations for previously operated patients
  patients

Clavicle fractures are very common among snowboarders. Not in
every place where there is a ski resort, there is also a clinic ready to operate on a fracture.
In addition, not every insurance includes a ski injury – you need to be very
careful when insuring. If the patient comes to us after the operation
– specialists of the Ilyinsky hospital perform X-ray or CT
study, and, depending on its results, determine the optimal mode
rehabilitation or additional treatment.

Do they join the army with a broken collarbone? — AppealNo

Time to read the article: ≈ 3 minute(s)

Clavicle fracture accounts for 15% of the total number of fractures. The number of conscripts with a history of this injury is large, so it is impossible to unequivocally answer the question of whether they take to the army with a broken collarbone. If the rehabilitation period is not over, the young man is entitled to a delay. But after the complete fusion of the bone, the question of serving in the army will depend on how exactly the treatment was completed. If the treatment was carried out with the help of a metal structure, and it is not removed, in Russia the young man will be released from military service. We will talk about other grounds for assigning a non-conscription category with this injury in our article.

Fracture of the collarbone and the army

If the fracture happened recently, and the young man is undergoing treatment or rehabilitation , then in the current call he is granted deferment for health reasons. The timing of bone fusion and further recovery of upper limb function depends on many factors, such as age, general health, degree of injury, and method of treatment.

Complete recovery from a broken collarbone usually takes 6 to 12 weeks. The maximum period for granting a deferral for health reasons is 12 months.

If the fracture has healed, and the function of the injured limb has not been disturbed in any way, conscripts recognize fit for military service.

There are situations when the fracture of the clavicle is very complex or there is displacement of fragments. For such an injury, conservative treatment is not enough, so doctors use a surgical method: install a metal plate to heal better and faster.

After the end of such treatment, if the plate does not cause discomfort to the patient, it is not removed. According to article 81 of the Schedule of Diseases, the presence of an unremoved metal structure on the collarbone is the basis for determining the category of validity “B” (limited validity) .

What if the collarbone fracture did not result in an exemption?

If it is initially clear that the fracture will not be grounds for exemption from military service, it is actively to check your health during the period of deferment for rehabilitation and treatment.

EXPERT EXPERIENCE

“Unfortunately, no one is immune from fractures. The presence of an unremoved metal structure on the collarbone suggests exemption from military service. Do not forget that it is important to record all visits to doctors and keep medical records. It is on this information that specialist doctors will be based on the medical examination .

Vladislav Neklyudov , lawyer-expert of PryzivaNet.

Q&A

What can not be done with a broken collarbone?

The most important thing not to do with any fracture is to try to treat it yourself. Incorrect bone union will lead to dysfunction of the limb, and further intervention will be more serious, so you should immediately consult a doctor.

During treatment, it is necessary to exclude physical activity on the injured limb and follow all doctor’s recommendations . You can not remove the immobilizing dressings, loosen them yourself or make them tighter, as this can lead to complications, and the treatment of the fracture will be delayed.

Why does the collarbone break easily?

This is due to its anatomical features: this small, thin bone is the only link between the upper limb and the trunk, and is therefore subject to great stress and risk of injury.