Clavicle Fracture

The clavicle — your collarbone — is the bone you can feel running across the top of your chest from your shoulder to your throat. Clavicle fractures make up about 5% of all broken bones, most often in young men and athletes who took a direct hit to the shoulder or fell hard on an outstretched arm. About 80% happen in the middle third of the bone; the ends (close to the shoulder or close to the throat) break less often. Most heal well in a sling without surgery. But fractures where the broken ends have shifted significantly or shortened the bone have a higher chance of healing crooked, and surgery is becoming more common for those.

A broken collarbone usually happens in an instant — a direct blow to the point of your shoulder in a collision, a fall from a bike, or a hard landing on an outstretched arm. You'll feel a sharp crack or pop, and pain will immediately prevent you from raising the arm on that side. Most people instinctively cradle the injured arm against their body for support, and any attempt to move the shoulder or take a deep breath will sharpen the pain.

Swelling develops rapidly over the fracture site, and you can often see or feel the deformity — a visible bump where the broken ends have shifted apart or ridden over each other, or a drooping shoulder that looks lower than the uninjured side. Bruising spreads across the upper chest and shoulder within a day or two. In displaced fractures the skin over the bump may be stretched thin and tenting — if you see skin blanching white over the break, that's a reason to be seen the same day.

Pain, swelling, and often a visible or feelable bump where the bone has shifted. A standard shoulder X-ray confirms the fracture. A second angled view (the Zanca view) helps your surgeon judge how much the fragments have displaced. A CT scan is added for fractures at the outer end, near the AC joint.

Surgery is required when there's osteomyelitis (bone infection), an open fracture (the bone broke through the skin), the skin over the fracture is being stretched so thin it's about to tear, an injury to the blood vessels nearby, or a floating shoulder (a clavicle fracture combined with a scapula fracture). Surgery is also considered — though not strictly required — when the bone has shortened more than about 2 cm, when the broken ends are completely overlapped, or when an active athlete wants the faster, more predictable recovery surgery offers.

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Shoulder (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language