Broken collarbone – NHS

A broken collarbone, or fractured clavicle, is a common injury. It usually happens after a fall or a blow to the shoulder.

It takes about 6 to 8 weeks to heal in adults, and 3 to 6 weeks in children.

The collarbone is a long, slender bone that runs from the breastbone to each shoulder.

You can feel it at the top of your chest, just below your neck. Tough bands of tissue (ligaments) connect the collarbone to the breastbone and shoulder blades.

When to get medical help

If you think you have injured your collarbone go to your nearest urgent treatment centre or call NHS 111 for advice.

If the the injury is severe – for example, the bone is poking through the skin or the pain is unbearable –  immediately call 999 or go straight to your nearest A&E department.

What you should do

While waiting to see a doctor, stabilise your arm using a towel as a sling – this goes under the forearm and then around the neck. Try to move your arm as little as possible.

Painkillers, such as paracetamol or ibuprofen, can help reduce the pain. Do not give aspirin to children under the age of 16.

Holding an ice pack to the injured area can also help reduce the pain and swelling. A bag of frozen peas wrapped in a tea towel works well. But do not put ice directly onto your skin because it can burn.

Symptoms of a broken collarbone

A cracked or broken collarbone will be very painful. There may also be:

• swelling or tenderness around the injured area
• bruising to the skin
• bleeding if the bone has damaged the tissue and skin (this is rare)
• numbness or pins and needles if nerves in the arm are injured

Your shoulder may be slumped downwards and forwards under the weight of the arm, as the broken collarbone is no longer providing support.

There may have been a snapping or grinding noise when your collarbone broke. In severe cases, one end of the bone may poke through the skin.

Treating a broken collarbone

Most broken collarbones are left to heal naturally using a simple triangular sling to support the arm and hold the bones together in their normal position.

The sling is usually fitted in hospital after an X-ray has confirmed the collarbone is broken. You’ll be given painkillers to relieve the pain.  

Surgery under a general anaesthetic is only needed if the injury is severe – for example, where the bone has broken through the skin – or if the bones have failed to line up and are overlapping significantly.

Several techniques can be used to repair the collarbone. Fixing the break with a plate and screws is the most common method. Your surgeon will explain the technique they’re going to use and its advantages and disadvantages.

Being discharged

You may need to stay in hospital overnight, depending on the extent of the injury.

Before you’re discharged, you may see a physiotherapist, who can show you some gentle arm and shoulder exercises to do at home with your arm out of its sling. These will help reduce stiffness, relieve some of the pain, and strengthen your shoulder muscles.

Follow-up

You’ll probably need to go back to the hospital outpatient department about a week after being discharged to check your collarbone is healing properly. See your GP if you have any concerns before this appointment.

Go back to the A&E department if you notice any weakness developing in your arm or hand, or the pain suddenly gets worse.

How long does it take to heal?

In adults, it usually takes about 6 to 8 weeks for a broken collarbone to heal, although it can take longer. In children, it usually takes about 3 to 6 weeks to heal.

However, it will take at least the same period again to restore full strength to your shoulder.

While the fracture heals, a lump may develop along your collarbone. This is normal, and often improves over the following months.

Occasionally, the fracture does not heal and you may need surgery. This should be discussed with your surgeon.

Recovery advice

While recovering from a broken collarbone you may find it helpful to:

• use extra pillows at night to keep yourself more upright if you find sleeping uncomfortable
• use ice packs and painkillers if pain and swelling continues while your arm is in a sling
• move your elbow, hand and fingers regularly as soon as it’s comfortable to do so
• remove the sling for short periods of time if it is not too painful (when you think the fracture has started to heal)
• do not play contact sports for at least 10 to 12 weeks after the injury – your doctor will tell you when you can go back to work and resume normal activities

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Clavicle Fractures | Johns Hopkins Medicine

Where is the clavicle?

The clavicle is the bone that connects the breastplate (sternum) to the shoulder. It is a very solid bone that has a slight S-shape and can be easily seen in many people. It connects to the sternum at a joint with cartilage called the sternoclavicular joint. At the other end, the bone meets the shoulder area at a part of the shoulder blade (scapula) called the acromion. The joint at that end of the bone containing cartilage is called the acromioclavicular joint.

The collarbone acts as a strut to connect the sternum to the shoulder blade. Because of the critical location of the clavicle, any severe force on the shoulder, such as falling directly onto the shoulder or falling on an outstretched arm, transfers force to the clavicle. As a result, the collarbone is one of the most commonly broken bones in the body.

How do you know if you have a clavicle fracture?

When bones break, there is swelling due to bleeding from the blood vessels in and around the bone. There is also pain from the broken bone due to damage of microscopic nerve endings around the bone. Sometimes the bone is broken enough to create an angle between the broken ends, which causes a deformity along the bone. Usually with a broken collarbone the pain and swelling are severe and there may be a visible deformity. Often there is pain at the site of the fracture with any attempt to move the arm. The only way to verify if there is a fracture is to get an X-ray of the area.

What should be done if you think your clavicle is fractured?

If you think that the clavicle is broken, it is best to seek medical treatment right away. The best way to treat the injury until you can reach a physician or emergency facility is to immobilize the arm and shoulder by holding the arm close to the body with the other arm or in a sling. You should put ice on the injured area for 20 to 30 minutes at a time, making sure not to freeze the skin. Pain medication such as Tylenol or over-the-counter nonsteroidal agents such as ibuprofen or naproxen (Advil or Aleve, for example) are acceptable. The only time you should not take medication is if there is a break in the skin over the fracture, which indicates that the ends of the bones may have punctured the skin. In that case, the fracture may need surgery to clean out any dirt or debris. Other indications of more severe injury include tingling, numbness or weakness in the hand or arm. If the injury is near the sternum and you have shortness of breath or difficulty swallowing you should seek immediate medical attention.

What is the treatment for a clavicle fracture?

The first thing the physician will do is take an X-ray to determine if the clavicle is broken, where the fracture is located and how many pieces it is broken into. Clavicle fractures are basically divided into three types based upon location. Fractures near the sternum are the least common (less than 5 percent of all clavicle fractures). Fractures near the AC joint are the second most common and can come in many different patterns. The most common fractures of the clavicle are in the middle of the shaft of the bone, approximately halfway between the sternum and the AC joint.

The most common way to treat the fractures in the middle is with immobilization with either a sling or a special bandage called a figure-of-8 splint. Studies have shown that these fractures heal just as quickly and as well with a sling as with the figure-of-8 splint, so we recommend a sling in a majority of cases. The figure-of-8 splint is generally uncomfortable, difficult to wear nonstop for six or eight weeks and can result in skin problems and a smelly patient because it should not be removed to wash the armpit. Figure-of-8 splints are not indicated or useful in fractures of the clavicle near the AC joint. However, some orthopaedic doctors have strong opinions about the use of this figure-of-8 device, and it can produce an acceptable result.

The second thing that helps in the treatment of clavicle fractures is pain relief with cold therapy and pain medication. It is recommended that you ice the fractured area for 15 to 20 minutes every two hours for as long as necessary to decrease the pain and swelling. Heat is not recommended. Pain medication in the form of narcotics is the best for relief of pain from a fractured clavicle, and you may need it for several weeks, especially to help you sleep. Many patients with this injury have to sleep sitting up to be comfortable. Other pain-relieving medications such as acetaminophen or nonsteroidal medications may be used, but they generally will not be adequate by themselves until the pain and swelling start to subside.

How long does a clavicle fracture take to heal?

How long it takes the fracture to heal depends upon many factors, such as age, the location of the fracture and how many pieces it is broken into. Clavicle fractures in children (younger than 8 years old) may heal in four or five weeks, and clavicle fractures in adolescents may take six to eight weeks. However, fractures in adults or teenagers who have stopped growing take 10 to 12 weeks to heal and may take longer. Most clavicle fractures will heal completely by four months in an adult. There are some indications that clavicle fractures broken into more pieces take longer than ones with a fewer fragments.

What can be done while waiting for a clavicle fracture to heal?

Within a few days of the fracture you should be able to move your fingers, wrist and elbow without too much discomfort. As the pain in the clavicle area improves you should be able to begin moving the shoulder joint a little to prevent the joint from tightening up too much. If the shoulder joint gets stiff, it is a condition known as a frozen shoulder. Usually as the pain in the fracture begins to subside, it is acceptable to begin moving the shoulder. Your physician may show you the motions or send you to a physical therapist for instructions. Generally motion of the shoulder does not prevent clavicle fractures from healing once the fracture has begun to heal.

Once the fracture has healed, motion is generally not restricted. It may take months before the fracture has healed enough to withstand contact such as in sports. Strengthening of the shoulder and arm should wait until the fracture has healed. Exercises should not be done until directed by your physician. Also, individuals who want to stay aerobically fit can usually begin light exercise such as walking or exercise biking after a few weeks, with the permission of their physician.

What result can be expected once a clavicle fracture heals?

Usually there are no limitations once the fracture heals. Most patients have full range of motion and can return to activities with no limitations. Some fractures can take six to nine months to heal. If the fracture does not heal, surgery may be necessary. Some fractures of the clavicle that do not heal completely are not painful and may not need surgery. Many factors determine whether a clavicle fracture will need surgery, and they should be discussed with your doctor. Generally, if surgery is necessary it is done with an incision followed by implanting a plate and screws. Sometimes a bone graft may be needed to help stimulate healing. Treatment after surgery depends upon many factors, such as how fast the fracture heals. Fortunately surgery is needed in few cases and is successful in cases where it is needed. Surgery can reduce a visible deformity of the fracture but results in a scar. Occasionally surgery may be indicated in a high-caliber athlete but this too is controversial and studies are mixed on when exactly surgery should be done.

Are fractures near the AC joint any different?

Fractures near the AC joint also can usually be treated without surgery. If there are torn ligaments associated with the fracture, then surgery may be indicated, although it is controversial. The pluses and minuses of surgery should be discussed with your doctor. Fortunately fractures of the clavicle near the AC joint need surgery only a small percentage of the time (less than 10 percent overall).

How to diagnose a clavicle fracture – advice from a traumatologist

How to diagnose a fracture of the clavicle – advice from a traumatologist

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How to Diagnose a Clavicle Fracture : A clavicle fracture is a complete or partial disruption of the integrity of the clavicle bone when a load exceeds the strength of the injured skeletal area. Primary diagnosis of a clavicle fracture will require an X-ray or CT scan of the clavicle and subsequent consultation with a traumatologist.

Which doctor treats a clavicle fracture : If you have symptoms of a clavicle fracture, you should first contact a traumatologist, based on the results of the initial examination, the doctor may prescribe an additional consultation with the surgeon.

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Clavicle fracture is a common injury in traumatology practice. The collarbone is a long, thin bone that runs from the sternum to each shoulder. You can feel it in the upper chest, just below the neck. Muscles and tendons connect the collarbone to the sternum and shoulder blades. A clavicle fracture usually occurs after a fall or a blow to the shoulder. It may be accompanied by a rupture of the clavicular muscles and tendons. It usually takes 6 to 8 weeks for adults to heal, and 3 to 6 weeks for children.

Clavicle fracture symptoms

Cracked or broken collarbone causes severe pain. In addition, the patient may experience:

• swelling or tenderness around the collarbone;
• bruise on skin;
• bleeding if bone has broken tissue and skin;
• numbness of the arm;
• tingling sensation in the arm;
• A disposition of the shoulder that can be pulled down and forward under the weight of the arm because the broken collarbone no longer supports it.

When the collarbone is broken, the patient may hear cracking or grinding. In severe cases, one end of the bone may pierce the skin.

Clavicle Fracture Diagnosis

See a traumatologist immediately if you have injured your collarbone. If your doctor suspects a clavicle fracture based on the results of the examination, you will be sent for an X-ray or CT scan to confirm the injury. If the injury to the collarbone is severe, such as a bone punctures the skin, or the patient experiences severe pain and difficulty breathing, go to the nearest emergency room or hospital immediately. This condition is life threatening.

Clavicle Fracture First Aid

While waiting for trauma care, stabilize your arm using a towel as a bandage. Tie it under your forearm and then around your neck.

Try to move your arm as little as possible.

Pain relievers such as paracetamol or ibuprofen can help relieve pain.

But do not give aspirin to children under 16 years of age.

Apply an ice pack to the injured area to reduce pain and swelling, but do not apply ice directly to the skin.

Broken collarbone treatment

Most collarbone fractures are left to heal naturally with a simple triangular bandage that supports the arm and holds the bones together in their normal position. The bandage is usually applied in an emergency room or hospital after an x-ray or CT scan confirms that the collarbone is broken.

After primary care, the doctor will refer the patient to a physiotherapist. He will show you some gentle arm and shoulder exercises that you can do at home without removing your arm from the bandage. This will help reduce stiffness, relieve pain, and strengthen the shoulder muscles.

Adults usually take 6 to 8 weeks to heal a broken collarbone. In children, healing usually takes 3 to 6 weeks. While the fracture heals, a lump may form along the collarbone. This is normal and the pineal mass usually disappears within the next few months. Sometimes a clavicle fracture does not heal and the patient may need surgery. Also, surgery under general anesthesia is sometimes necessary if the injury to the collarbone is severe, such as when a bone has torn through the skin, if the bones do not line up and overlap significantly. Several methods can be used to surgically repair the clavicle. Fastening the gap with a plate and screws is the most common of them. Your surgeon will explain the technique he is going to use and the advantages and disadvantages of each clavicle repair surgery.

Tips for recovering from a broken collarbone

When recovering from a broken collarbone, the patient may benefit from:

• use extra pillows at night to stay upright while sleeping;
• use ice packs and painkillers if pain and swelling continue while the arm is in a bandage;
• regularly move the elbow, hand and fingers as soon as it is convenient;
• remove the bandage for a short time;
• do not engage in contact sports for at least 10-12 weeks after the injury.

Author: Bogatov Nikita Dmitrievich

Specialization: Manual Therapy, Osteopath

Place of appointment: MRI Center and Clinic RIORIT, Incentro Clinic

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Literature

1. Anisimov A. I., Kornilov N.V., Kanykhin A.V. Electrochemical aspects of implantation of metal structures in traumatology and orthopedics // Sixth congress of traumatologists and orthopedists of Russia: abstracts of reports. – Nizhny Novgorod, 1997. – P.359.
2. Babushkin Yu.N., Konev V.P., Lanshakov V.P. Surgical treatment of fractures of the clavicle // Scientific and practical. conf. with international participation “New technologies in medicine”: abstracts of reports. – Kurgan, 2000. – Part 1. – P. 240.
3. Beydik O.V., Evdokimov M.M., Romakina N.A. Surgical treatment of clavicle fractures using external fixation devices. // Genius of orthopedics.- 2003.-№2. – S. 45-49.
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5. Sushko G.S. Treatment of clavicle fractures by the method of extrafocal osteosynthesis // Treatment of orthopedic and trauma patients in a hospital and clinic by the method of transosseous osteosynthesis developed by KNIIEKOT: Proceedings. report All-Union. scientific-pract. conf. – Kurgan, 1982. – T.1. – S. 93-95.
6. Sandstrom CK, Gross JA, Kennedy SA. Distal clavicle fracture radiography and treatment: a pictorial essay. Emerge Radiol. 2018 Jun;25(3):311-319. doi: 10.1007/s10140-018-1586-y. Epub 2018 Feb 3.PMID: 29397463.
7. Fujimoto K, Kato H, Kaneko Y, Aoki M, Kuze B, Kato K, Shibata T, Matsuo M. Clavicle fracture following neck dissection: imaging features and natural course. Br J Radiol. 2019 Aug;92(1100):201. doi: 10.1259/bjr.201. Epub 2019 May 22. PMID: 31116575; PMCID: PMC6724636.
8. Kim JH, Gwak HC, Kim CW, Lee CR, Kim YJ, Seo HW. Three-dimensional clavicle displacement analysis and its effect on scapular position in acute clavicle midshaft fracture. J Shoulder Elbow Surg. 2019Oct;28(10):1877-1885. doi: 10.1016/j.jse.2019.03.019. Epub 2019 Jul 2. PMID: 31272891.

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Fracture of the collarbone is a fairly common injury, especially in adolescents and young adults. The clavicle connects the upper part of the sternum to the shoulder blade. The most common cause of a clavicle fracture is falls, sports injuries, and injuries during traffic accidents. Newborns sometimes have a collarbone fracture during the birth process. If you suspect a clavicle fracture, you should definitely consult a doctor. In most cases, a clavicle fracture is treated conservatively with a bandage and physical therapy. Complex fractures of the clavicle require surgical treatment with fixation with plates, screws or rods, which allows the bone tissue to consolidate.

Symptoms

Symptoms of a clavicle fracture include:

• pain that worsens with movement of the shoulder
• edema
• soreness
• contusion
• presence of swelling in the shoulder area
• grinding or crackling when trying to move the shoulder
• stiffness or inability to move the shoulder

Therefore, if there are signs or symptoms of a broken collarbone or if there is pain in the shoulder that does not allow normal movement of the shoulder, then it is imperative to see a doctor. Untimely diagnosis and treatment of a clavicle fracture can lead to slow healing of the fracture.

Causes

The most common causes of a clavicle fracture include:

• Falls. A fall on your shoulder or on an outstretched arm can lead to a broken collarbone.
• Sports injuries. A direct blow to the shoulder while playing on the field (football, hockey, etc.) or martial arts in the ring can cause a fracture of the collarbone.
• Automobile injuries. A broken collarbone can result from an accident while driving a car, motorcycle, or bicycle.
• Birth trauma. In newborns, a clavicle fracture can occur during the birth process.
• Young age is a risk factor, as the bone tissue of the clavicle finally completes its formation by the age of 20. And therefore, adolescents and young adults are at higher risk for a collarbone fracture. The risk of fracture also increases in old age, as the strength of bone tissue decreases due to the development of osteoporosis.

Complications

In most cases, a clavicle fracture heals without sequelae. But sometimes the following complications are possible:

• Damage to nerves or blood vessels. The pointed ends of a broken collarbone can damage nearby nerves and blood vessels and, in such cases, it can cause numbness or coldness in the hand.
• Poor or slow healing. With a severe fracture of the clavicle, the consolidation of bone fragments may be slow or incomplete. Poor alignment of bone fragments can lead to shortening of the clavicle, which leads to a violation of the normal range of motion in the shoulder.
• Bone outgrowths may be part of the bone regeneration process (bone callus) and are visible because the clavicle is not deep under the skin. But callus usually disappears after a while. But sometimes bone growths persist for a long time.
• Bone infections. In cases where fragments of the clavicle violate the integrity of the skin, then there is the possibility of infection penetrating into the bone tissue. Therefore, timely adequate treatment for such fractures is of great importance.
• Arthrosis. If a clavicle fracture occurred in the joint area at the junction with the sternum or scapula, then there is a certain risk of developing arthrosis of these joints.

Diagnosis

During a physical exam, the doctor examines the injured area for tenderness, swelling, deformity, or an open sore. X-rays are usually sufficient to diagnose a clavicle fracture. In some cases, an additional examination (CT or MRI) may be prescribed to diagnose possible soft tissue damage in a clavicle fracture.

Treatment

Immobilization is a prerequisite for a fracture of any bone (including the collarbone). In case of a clavicle fracture, immobilization can be performed using a kerchief bandage or using Delbe rings, which make it possible to preserve the length of the clavicle to a greater extent after consolidation of bone fragments.

The duration of immobilization depends on the severity of the fracture. Typically, clavicle bone regeneration takes 3 to 6 weeks in children and 6 to 12 weeks in adults.