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Healing time for broken collarbone: Broken collarbone recovery time | TRIA blog

Broken Collarbone Symptoms, Diagnosis, Treatment, and Care

Broken Collarbone Symptoms, Diagnosis, Treatment, and Care

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Medically reviewed by William Morrison, M. D. — By Marjorie Hecht — Updated on September 25, 2018

Overview

The collarbone (clavicle) is a long slender bone that connects your arms to your body. It runs horizontally between the top of your breastbone (sternum) and shoulder blades (scapula).

Broken collarbones (also called clavicle fractures) are fairly common, representing about 5 percent of all adult fractures. Clavicle fractures are even more common in children, representing between 8 and 15 percent of all child fractures.

A 2016 Swedish study found that 68 percent of clavicle fractures occurred in males. The 15- to 24-year-olds represented the largest age group among males, at 21 percent. But in people older than 65, more women than men had broken collarbones.

Each fracture is different, but 80 percent of them occur in the middle part of the collarbone, which isn’t strongly attached by ligaments and muscles.

Sports injuries, falls, and traffic accidents are the most frequent causes of broken collarbones.

When you break your collarbone, you’re likely to be in a lot of pain and have trouble moving your arm without causing more pain. You may also have:

  • swelling
  • stiffness
  • inability to move your shoulder
  • tenderness
  • bruising
  • a bump or raised area over the break
  • grinding or crackling noise when you move your arm
  • forward sagging of your shoulder

The most frequent cause of broken collarbones is a direct blow to the shoulder that snaps or breaks the bone. This can occur in a downward fall landing on your shoulder, or falling onto an outstretched arm. It can also happen in a car collision.

Sports injuries are a common cause of broken collarbones, especially in younger people. The clavicle doesn’t fully harden until you’re about 20.

Contact sports like football and hockey can lead to shoulder injuries, as can other sports where a fall usually happens at high speeds or on a downward trajectory, such as skiing or skateboarding.

Infants

Newborns can have their clavicle fractured during delivery. It’s important for parents to notice if your baby has any of the symptoms of a broken collarbone, such as crying when you touch their shoulder.

Your doctor will ask you about your symptoms and how the injury occurred. They’ll also examine your shoulder, and likely ask you to try to move your arm, hand, and fingers.

Sometimes the location of the break will be evident, because your bone will be pushing up under your skin. Depending on the type of break, the doctor may want to check to see if nerves or blood vessels were also damaged.

The doctor will order shoulder X-rays to show the exact location of the break, how much the bone ends have moved, and whether other bones are broken. Sometimes they’ll also order a CT scan to look at the break or breaks in more detail.

Treatment for a broken collarbone depends on the type and severity of your fracture. There are risks and benefits to both nonsurgical and surgical treatments. It’s best to fully discuss your treatment options with your doctor.

In the past, nonsurgical treatment for a break in the middle part of the clavicle was thought to be best. But in the last several years, a 2016 study reported, surgical treatment became predominant.

A 2015 meta-analysis of surgical and nonsurgical treatment noted that complication rates were 25 percent, no matter which treatment was chosen. Both studies called for more research to determine what kinds of breaks benefit most from surgery.

Conservative, nonsurgical treatment

With nonsurgical treatment, here’s what you can expect:

  • Arm support. Your injured arm will be immobilized in a sling or wrap to keep the bone in place. It’s important to restrict movement until your bone has healed.
  • Pain medication. A doctor may prescribe over-the-counter drugs such as ibuprofen or acetaminophen.
  • Ice. A doctor may recommend ice packs to help with pain for the first few days.
  • Physical therapy. A doctor or a physical therapist may show you gentle exercises to prevent stiffness as your bones are healing. Once your bones have healed, your doctor can advise a rehabilitation program to help your arm gain strength and flexibility.

One complication of conservative treatment is that the bone may slip out of alignment. This is called malunion. You may need further treatment, depending on how malunion affects your arm function.

In some cases, you may have a bump on your skin above the break. The bump usually gets smaller in time.

Surgery

If your broken collarbone is fragmented, fractured in more than one place, or badly aligned, surgery may be recommended. Typically, treating complex breaks involve:

  • repositioning your collarbone
  • placing metal screws and a metal plate or pins and screws alone to hold the bone in place so that it heals properly
  • wearing a sling after surgery to immobilize the arm for a few weeks
  • taking painkillers as prescribed after surgery
  • having follow-up X-rays to monitor healing

Pins and screws are removed once the bone has healed. Metal plates are typically not removed unless there is irritation of the overlying skin.

There may be surgical complications, such as problems with the bone healing, irritation from the inserted hardware, infection, or injury to your lung.

Doctors are currently researching minimally invasive arthroscopic surgery for broken collarbones.

Broken collarbone in children | Treatment for children

Broken collarbones in children usually heal without surgery. There are few reports of complications in medical literature.

Broken collarbones usually take six to eight weeks to heal for adults and three to six weeks in young children. Healing times vary depending on the individual fracture.

In the first four to six weeks, you shouldn’t lift anything heavier than five pounds or try to raise your arm above shoulder level.

Once the bone has healed, physical therapy to get your arm and shoulder back to normal function will likely take another few weeks. In general, people can get back to regular activities in three months.

Sleeping

Sleeping with a broken collarbone may be uncomfortable. Remove the sling at night, and use extra pillows to prop yourself up.

Pain management

Use over-the-counter painkillers to manage pain. Ice packs may also help.

Physical therapy

Stick with a gentle physical therapy routine to keep your arm from stiffening while it’s healing. This may include some soft tissue massage, squeezing a ball in your hand, and isometric rotation. You may move your elbow, hands, and fingers as it becomes comfortable to do so.

Once the break has healed, your doctor or physical therapist can give you exercises to strengthen your shoulder and arm. These may include range-of-motion exercises and graduated weightlifting.

Your doctor will assess when you go back to your normal activities. They’ll also advise when you can begin specific training for a return to sports. For children, this can be in six weeks for non-contact sports and eight to 12 weeks for contact sports.

Broken collarbones are fairly common and usually heal without complications. Each case is unique. Discuss with your doctor whether surgical or nonsurgical treatment might be best for you.

It’s important to stick with a physical therapy routine to regain full use of your arm and shoulder.

Last medically reviewed on September 24, 2018

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

  • Broken collarbone. (2017).
    nhs.uk/conditions/broken-collarbone/
  • Broken collarbone (clavicle fracture). (2018).
    kidshealth.org/en/teens/clavicle-fracture.html
  • Clavicle fracture. (2014).
    rchsd.org/health-articles/clavicle-fracture/
  • Clavicle fracture (broken collarbone). (2016).
    orthoinfo.aaos.org/en/diseases–conditions/clavicle-fracture-broken-collarbone/
  • Henry PDG. (2016). Treating fracture of the clavicle. DOI:
    doi.org/10.1503/cmaj.150962
  • Karaoğlu S, et al. (2002). Results of conservative treatment of displaced mid-clavicular fractures in adults [Abstract].
    ncbi.nlm.nih.gov/pubmed/12510104
  • Kihlström C, et al. (2017). Clavicle fractures: Epidemiology, classification and treatment of 2,422 fractures in the Swedish Fracture Register; an observational study. DOI:
    doi.org/10.1186/s12891-017-1444-1
  • Kim Y-S et al. (2017). Arthroscopic fixation of the clavicle shaft fracture: Technical tricks. DOI:
    doi.org/10.1177/2309499016684411
  • Lenza M, et al. (2013). Surgical versus conservative interventions for treating fractures of the middle third of the clavicle [Abstract]. DOI:
    doi.org/10.1002/14651858.CD009363.pub2
  • Nourian A, et al. (2017). Midshaft fractures of the clavicle: A meta-analysis comparing surgical fixation using anteroinferior plating versus superior plating [Abstract]. DOI:
    doi.org/10.1097/BOT.0000000000000936
  • O’Neill BJ, et al. (2011). Conservative management of paediatric clavicle fractures. DOI:
    doi.org/10.1155/2011/172571
  • Ranalletta M, et al. (2015). Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes [Abstract]. DOI:
    doi.org/10.1177/0363546514559913
  • Vander Have, KL et al. (2010). Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents [Abstract]. DOI:
    doi.org/10.1097/BPO.0b013e3181db3227
  • Woltz S et al. (2017). Plate fixation compared with nonoperative treatment for displaced midshaft clavicular fractures: A multicenter randomized controlled trial [Abstract]. DOI:
    doi.org/
    10.2106/JBJS.15.01394
  • Devji T, et al. (2015). Operative versus nonoperative interventions for common fractures of the clavicle: a meta-analysis of randomized controlled trials. DOI:
    doi.org/10.9778/cmajo.20140130

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Medically reviewed by William Morrison, M.D. — By Marjorie Hecht — Updated on September 25, 2018

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Broken Collarbone Surgery Rehab Protocol & Recovery Time

  • DO NOT elevate surgical arm above 90 degrees in any plane for the first 4 weeks post-op.
  • DO NOT lift any objects over 5 pounds with the surgical arm for the first 6 weeks.
  • AVOID REPEATED reaching for the first 6 weeks.
  • recommend regular icing routine for the first 2 weeks; please consult Post-Op Icing handout for full details
  • An arm sling is used for 4 weeks post-op.
  • Maintain good upright shoulder girdle posture at all times and especially during sling use.
  • Intermittent X-ray to monitor healing as needed
  • M.D./nurse follow-up visits at Day 2, Day 14, Month 1, Month 3 and Year 1 post-op.

Week 1

  • MD/nurse. visit day 2 post-op to change dressing.
  • Exercises (3x per day):
  1. Pendulum exercises,
  2. squeeze ball,
  3. triceps with Theraband,
  4. isometric rotator cuff external and internal rotations with arm at side
  5. isometric shoulder abduction, adduction, extension and flexion with arm at side. -Soft tissue treatments for associated shoulder and neck musculature for comfort
  • cardiovascular training such as well arm cycling, biking for Active Recovery

Weeks 2 – 4

  • Soft tissue treatments for associated shoulder and neck musculature for comfort.
  • Gentle pulley for shoulder ROM 2x/day in limited ROM <90*
  • elbow pivots PNF, wrist PNF
  • isometric scapular PNF, mid-range

Weeks 4 – 8

  • M.D. visit at Week 4 post-op and will usually be progressed to a more aggressive ROM and strength program.
  • At Week 4: start mid-range of motion (ROM) rotator cuff external and internal rotations active and light resistance exercises (through 75% of ROM as patient’s symptoms permit) without shoulder elevation and avoiding extreme end ROM.
  • Strive for progressive gains to active 90 degrees of shoulder flexion and abduction.

Weeks 8 – 12

  • Seek full shoulder Active ROM in all planes
  • Increase manual mobilizations of soft tissue as well as glenohumeral and scapulothoracic joints for ROM.
  • No repeated heavy resisted exercises or lifting until 3 months.

Weeks 12 and beyond

  • Start a more aggressive strengthening program as tolerated.
  • Increase the intensity of strength and functional training for gradual return to activities and sports.
  • Return to specific sports is determined by the physical therapist through functional testing specific to the patient’s demands
  • completion of Sports Test I for initial return to sports and progressive sport-specific training

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.


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Explore all your options. Learn about procedures that can help you return to sports & delay or avoid an artificial shoulder replacement.

Clavicle fracture treatment, diagnostics in the best clinics of the world: 169 clinics, prices, reviews

A clavicle fracture is an injury to the bone that connects the chest to the shoulder girdle. This type of injury is quite common, accounting for about 90,003 5% of 90,004 of all fractures in adults. If the fracture has led to bone fragmentation or is open, foreign doctors prescribe a surgical operation. It involves the use of plates, screws, or rods to hold the bone in place while it heals.

Read more about methods of treating a fracture of the clavicle abroad below.

Clavicle fracture treatment cost abroad:

Procedure/country Türkiye Spain Germany
Medical consultation from $100 from $350 from $400
MRI from $500 from $1200 from $1200
Operation on request on request on request
Physiotherapy on request on request on request

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Rehabilitation Price on request

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06/03/2021

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Due to late diagnosis of advanced multiple myeloma, I spent a week in bed. While our hope was on the verge of destruction, fate brought us together with Dr. Tsilya Zuckerman. Her knowledge, experience, love for her work and the positive energy that she gives with her smiling face and pleasant language are not inferior to modern medicines. On the first day of hospitalization at the speed of a jet plane, all examinations were carried out. The chemotherapy program started on the second day, followed by a very successful transplant. My health, which has steadily improved over the past 14 months, has brought me back to life. Endless thanks to Dr. Cyla Zuckerman.

09/25/2021

Israel

I had a knee replacement by Dr. Yaron at Rambam Hospital. After the accident, I was in severe pain and was taken to the emergency room, however, Dr. Yaron was extremely helpful and accommodating. He performed emergency surgery on me and made sure I was back to my normal state of mobility.

Leyla

02.10. 2021

Spain

I saw Dr. Karen Drumea in 2016 for stage 3 breast cancer. And then I had peritoneal cancer. I received hyperthermia treatment, chemotherapy and herbal medicine support. My CA values, which had never dropped, began to drop rapidly. Both the doctor and her team are extremely involved. I am extremely grateful to her.

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09/11/2021

Ukraine

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Svetlana

05.05.2023

I recently underwent cancer treatment in Israel at Top Ichilov. The hospital is well equipped with the latest technology and the staff were professional and compassionate. My surgeon, Dr. Cohen, is a professional. The operation went smoothly and during my stay in the hospital I felt that I was well taken care of. The medical staff was attentive, and the pain was effectively stopped. After the operation, I received clear instructions for wound care and follow-up visits. I am grateful for the excellent service I received at Top Ichilov and would highly recommend her to anyone seeking thyroid cancer treatment in Israel.

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09/26/2021

Spain

We were looking for an experienced bone marrow transplant surgeon for my 7 year old son who was battling aplastic anemia. All this time since he was diagnosed, we have been very worried, and we have been looking for a suitable procedure to alleviate the condition of my son. Dr. Isaac Yaniv has proven himself to be the best choice, we heard good things about him and made an appointment. A few weeks later my son was scheduled for a bone marrow transplant and we waited for a miracle to happen. Dr. Isaac gave us hope and we trusted him completely. The operation was completed in just 2 hours and my son was followed up for 48 hours after the transplant. A few months later he recovered and regained his strength. I still thank Dr. Yaniv for his services and support.

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Diagnosis of a clavicle fracture abroad

When a clavicle is fractured, there is usually a clear deformity or bump at the fracture site. If you press on it, the patient experiences severe pain. After a physical examination and communication with the patient, the doctor prescribes the following tests:

  • x-ray to determine if the collarbone is broken, where the fracture is located and how many parts it is broken;
  • MRI and CT for more accurate images. In particular, they are prescribed if the patient is indicated for surgery.

Foreign medical centers are equipped with modern equipment that allows for accurate diagnosis. The quality of treatment and its effectiveness depend on its efficiency.

How is a clavicle fracture treated abroad?

Treatment of a clavicle fracture can vary depending on many factors. For example:

  • type and severity of fracture;
  • presence of concomitant injuries;
  • General health of the patient, etc.

In general, the following approaches are used abroad:

  • Conservative therapy. This treatment is used when the clavicle fracture is not too severe. The method involves wearing a bandage on the shoulder or chest to hold the collarbone in the correct position. The average wearing time is 3-4 weeks.
  • Physiotherapy . After the fracture has healed, the patient may be given physical therapy to restore mobility and strength in the shoulder joint. Experienced physiotherapists and rehabilitologists work abroad. They create an individual recovery plan for each patient.

Clavicle fracture surgery abroad

If the clavicle fracture is more severe, surgery may be required. There are several types of operations used by foreign orthopedic surgeons:

  1. Open reduction and fixation : a procedure in which the bones are first restored to the correct position (reposition) and then fixed together with special plates and screws. Reposition is carried out with the help of incisions in the area of ​​fractures.
  2. Closed reduction and fixation : an operation in which reduction is carried out through microscopic incisions in the skin. After fixing the position of the bones with nails or special plates.
  3. Implantation of Internal Fixation Systems : a procedure that uses a metal plate, nail or wire to fix bones in the correct position from the inside, without external wounds.
  4. Bone graft : The intervention involves the implantation of a piece of bone from another part of the body (or a donor bone) into a fractured collarbone.

Different treatments may be used abroad, depending on medical standards and available resources. If you are looking for a clavicle fracture clinic, contact the Clinics on Call coordinators. Specialists will select the best medical center abroad for you.

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Rehabilitation after clavicle fracture surgery abroad

Rehabilitation after surgery for a broken collarbone plays an important role in restoring shoulder function and preventing complications. The recovery plan is as follows:

  • Wear bandages or dressings: After surgery, the patient is advised to wear special bandages on the shoulder or chest to protect healing tissue and help stabilize the collarbone in the correct position.
  • Physical exercise: specific exercises help restore movement and strength in the shoulder joint.
  • Restriction of movement: a few days after surgery, the patient is advised to reduce physical activity. Lifting weights is prohibited.
  • Diet: calcium and vitamin D must be consumed.

The cost of treating a fracture of the clavicle abroad

As in any country, the cost of treating a fracture of the collarbone depends on various factors:

  • the complexity of the fracture;
  • selected treatment method;
  • doctor and hospital ratings;
  • duration of hospitalization;
  • number of diagnostic tests.

Average price of treatment abroad:

  • Turkey: $2,000 to $6,000;
  • Germany: $5,000 to $10,000;
  • Spain: $3,000 to $8,000;
  • Israel: $5,000 to $12,000.

Where can I get treatment for a broken collarbone abroad?

  • Turkey: there are many medical centers in the country that specialize in the treatment of various types of fractures. For example: Memorial, Anadolu, Acibadem, Medicana, Istanbul American Hospital.
  • Germany: Germany is known for its high quality medical care in the field of orthopedics. The best medical centers in the country: Asklepios, Helios Berlin-Buch, Charité.
  • Spain: clinics in the country offer quality medical care to patients who have experienced a fracture of the collarbone. You can get treatment at: Navarra Clinic, Quiron Salud Clinic Network, La Place University Hospital.
  • Israel: Known for its advanced medical technology, particularly orthopedics. Clavicle fracture can be cured in: Rambam Medical Center, Hospital named after. Sourasky (Ichilov), Sheba Medical Center.

Published:

03/16/2023


Alesya Lozova

Author, medical expert


Dr. Zeeshan Zaman (M.D)

Medical Author and Editor

Clavicle fracture symptoms and treatment of trichomoniasis

ICD-10 code:
S42.0 Clavicle fracture

Similar diseases:
Fracture of clavicle in children, Fracture of bones, Fracture of humerus, Closed fracture, Comminuted fracture, Displaced fracture, Open fracture,

Description
Fractured collarbone is a common injury, especially in children and young adults.
Common causes of Clavicle Fracture are falls, sports injuries, and injuries from traffic accidents. Babies can sometimes experience a collarbone fracture during the birth process.

Reasons
Common causes of collarbone fracture include:
1. Falling onto the shoulder or outstretched arm may result in a Clavicle Fracture.
2. Sports injuries. A direct blow to the shoulder from a sports injury on the field or rink can cause a collarbone fracture.
3. Car injury. A broken collarbone can be the result of a car accident.
4. Birth trauma. In newborns, a clavicle fracture can occur during the birth process.

Symptoms
If you suspect a fracture of the clavicle, you should consult a doctor. Most clavicle fractures heal with pain medication, bracing, and physical therapy. However, a complex clavicle fracture may require surgery. To reconstruct a broken bone, special plates, screws, or rods must be used.
Signs and symptoms of a Fractured Collarbone include:
– Pain that worsens with shoulder movement
– swelling in the area of ​​injury;
– crepitus when trying to move the shoulder;
– inability to move the shoulder.
Delay in diagnosis and treatment of a clavicle fracture can lead to poor healing of the injury.

Possible complications
The final ossification of the clavicle is completed by the age of 20. This causes an increased risk of clavicle fractures in children and adolescents. The risk decreases after age 20, but then rises again in the elderly as bone strength decreases with age.
In most cases, clavicle fractures heal without difficulty. But complications may include:
1. Damage to adjacent nerves or vessels. The jagged ends of a broken collarbone can damage nearby nerves and blood vessels. Seek medical attention if you feel numbness or coldness in your arm after a broken collarbone.
2. Delayed healing of injury. Poor consolidation of bone fragments during treatment can cause the clavicle to be shorter after healing than before injury.
3. Bone callus. As part of the healing process, the place where the bony processes fuse together is called a callus. This is easy to see as the clavicle is close to the skin. Although they usually disappear over time, in some cases the corn remains permanently.
4. Bone infections. If any part of the broken bone protrudes through the skin, there is an increased risk of developing a bone infection. Timely adequate treatment is crucial in this situation.
5. Arthrosis. If the fracture involves the joint that connects the collarbone to the shoulder blade or sternum, there is an increased risk of developing Arthritis in that joint.
6. Restriction of movement after fracture healing.

Treatment
The time required for immobilization depends on the severity of the injury. Bone healing usually takes 3 to 6 weeks for children and 6 to 12 weeks for adults. If a child breaks his collarbone during childbirth, treatment usually occurs without special methods. Pain control and gentle handling of the child is all that is usually required.
Medications.
To reduce pain and inflammation, your doctor may recommend pain medication. If the patient is in severe pain, pain medication can be taken for several days.
Rehabilitation begins shortly after the start of treatment. In most cases, you can start small hand movements already at the stage of fixation. This must be done in order to prevent contracture of the joint. After the fixation bandage is removed, the patient may be recommended additional rehabilitation exercises or physical therapy to restore muscle strength, joint mobility and flexibility.
Surgery may be necessary if the clavicle is fractured, if the fracture is open, or if the bone is broken into several pieces. The surgery involves the placement of fixation devices – plates, bolts or rods – that are needed to maintain the correct position of the bone while it heals. Surgical complications are rare but may include primarily bone infection.

Description
Fractured collarbone is a common injury, especially in children and young adults.
Common causes of a clavicle fracture are falls, sports injuries, and road traffic injuries. Babies can sometimes experience a collarbone fracture during the birth process.

Causes
Common causes of collarbone fracture include:
1. A fall on the shoulder or on an outstretched hand can lead to a fracture of the collarbone.
2. Sports injuries. A direct blow to the shoulder from a sports injury on the field or rink can cause a collarbone fracture.
3. Car injury. A broken collarbone can be the result of a car accident.
4. Birth trauma. In newborns, a clavicle fracture can occur during the birth process.

Symptoms
If you suspect a fracture of the clavicle, you should consult a doctor. Most clavicle fractures heal with pain medication, bracing, and physical therapy. However, a complex clavicle fracture may require surgery. To reconstruct a broken bone, special plates, screws, or rods must be used.
Signs and symptoms of a broken collarbone include:
– Pain that worsens with shoulder movement
– swelling in the area of ​​injury;
– crepitus when trying to move the shoulder;
– inability to move the shoulder.
Delay in diagnosis and treatment of a clavicle fracture can lead to poor healing of the injury.

Possible complications
The final ossification of the clavicle is completed by the age of 20. This causes an increased risk of clavicle fractures in children and adolescents. The risk decreases after age 20, but then rises again in the elderly as bone strength decreases with age.
In most cases, clavicle fractures heal without difficulty. But complications may include:
1. Damage to adjacent nerves or vessels. The jagged ends of a broken collarbone can damage nearby nerves and blood vessels. Seek medical attention if you feel numbness or coldness in your arm after a broken collarbone.
2. Delayed healing of injury. Poor consolidation of bone fragments during treatment can cause the clavicle to be shorter after healing than before injury.
3. Callus. As part of the healing process, the place where the bony processes fuse together is called a callus. This is easy to see as the clavicle is close to the skin. Although they usually disappear over time, in some cases the corn remains permanently.
4. Bone infections. If any part of the broken bone protrudes through the skin, there is an increased risk of developing a bone infection. Timely adequate treatment is crucial in this situation.
5. Arthrosis. If the fracture involves the joint that connects the collarbone to the shoulder blade or sternum, there is an increased risk of developing arthritis in that joint.
6. Restriction of movement after fracture healing.

Treatment
The time required for immobilization depends on the severity of the injury. Bone healing usually takes 3 to 6 weeks for children and 6 to 12 weeks for adults. If a child breaks his collarbone during childbirth, treatment usually occurs without special methods. Pain control and gentle handling of the child is all that is usually required.
Medications.
To reduce pain and inflammation, your doctor may recommend pain medication. If the patient is in severe pain, pain medication can be taken for several days.