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Shoulder

Clavicle Fracture

A clavicle fracture, commonly known as a broken collarbone, is a frequent injury that occurs when the clavicle (collarbone) breaks due to trauma. It is one of the most common fractures, accounting for up to 5% of all adult fractures and 10–15% of fractures in children.

Clavicle fractures can usually be treated nonoperatively with rest, a sling, and physical therapy, but in some cases—especially when the bone is significantly displaced—surgery may be recommended to restore alignment and function.

The clavicle is a long, thin bone that connects the:

  • Sternum (breastbone) at the midline of the chest
  • Scapula (shoulder blade) at the acromion (part of the shoulder)

It acts as a strut that supports the shoulder and allows for arm movement while protecting nerves and blood vessels beneath it.

The clavicle is divided into three regions:

  1. Medial third – closest to the sternum
  2. Middle third – most commonly fractured (~80% of cases)
  3. Lateral third – closest to the shoulder

Clavicle fractures typically result from trauma such as:

  • A fall onto the shoulder
  • A direct blow to the clavicle
  • Falls onto an outstretched hand or elbow
  • Sports injuries (e.g., football, biking, skiing)

Common signs and symptoms of a clavicle fracture include:

  • Immediate pain in the collarbone area after trauma
  • Swelling and bruising over the collarbone
  • A “bump” or visible deformity at the site of the break
  • Pain with shoulder or arm movement
  • Limited range of motion in the shoulder
  • Grinding or crunching (crepitus) with arm movement
  • In severe cases: skin tenting or open fracture if bone pierces the skin

The arm is often held close to the body, supported by the opposite hand.

History and Physical Exam

  • Consideration of the injury mechanism and symptoms.
  • Examination includes inspection, palpation for tenderness and deformity, and checking for nerve or blood vessel injury.

Imaging

  • X-rays: The main tool used to confirm the diagnosis and classify the fracture.
  • CT scans may be ordered for complex or comminuted (shattered) fractures, especially near the shoulder or if there is a concern for fractures next to larger vessels

Clavicle fractures are classified based on location:

  1. Middle Third (Midshaft) – most common
    • Can be displaced (bone ends separated) or nondisplaced
  2. Lateral Third – closer to the AC joint (shoulder end)
    • May be unstable due to ligament involvement
  3. Medial Third – least common
    • Often associated with high-energy trauma

Fractures can also be:

  • Simple (few fracture lines)
  • Comminuted (bone is broken into several pieces)
  • Displaced (bone fragments separated)
  • Nondisplaced (bone remains straight or in alignment)

Most clavicle fractures, especially nondisplaced or minimally displaced midshaft fractures, are treated without surgery.

Immobilization

  • A sling or figure-of-eight brace is used for 1–2 weeks to rest the shoulder and allow healing.
  • Healing can vary depending on patient age, nutritional status (eg., calcium, vitamin D), baseline bone health

Pain Control

  • Ice applied for 15–20 minutes several times per day during the first few days.
  • NSAIDs (ibuprofen, naproxen) or acetaminophen for pain relief.

Physical Therapy

  • Begins after the initial rest period.
  • Focuses on:
    • Gentle range of motion exercises
    • Gradual return to strengthening and function
    • Avoiding heavy lifting until bone heals

Activity Modification

  • Avoid contact sports and overhead lifting until cleared by a provider.

  • Most patients heal without complication.
  • Slight deformity or bump at the fracture site may remain but usually causes no long-term issues.
  • High healing rates in nondisplaced or mildly displaced fractures (>90%).

Surgery may be recommended for:

  • Significantly displaced fractures (bone ends are separated)
  • Comminuted fractures (multiple bone fragments)
  • Shortening of the clavicle >2 cm
  • Open fractures (bone pierces the skin)
  • Neurovascular injury
  • Floating shoulder (associated scapular fracture)
  • Athletes or manual laborers requiring faster and stronger return to full shoulder function

Surgical Procedure: Open Reduction and Internal Fixation (ORIF)

  • Involves making an incision over the clavicle
  • Bone fragments are repositioned (reduced) into normal alignment
  • Metal plate and screws are placed to hold the bone in position

  • Outpatient procedure (same-day discharge)
  • Sling worn for 2–4 weeks
  • Early range of motion exercises start within days after surgery
  • Physical therapy continued for 2–3 months
  • Return to full activity or sports: usually 3–6 months
  • Hardware removal: Sometimes needed if plate causes irritation, usually after 1 year

While generally safe, surgery has potential risks:

  • Infection
  • Hardware irritation
  • Nonunion or delayed healing
  • Nerve or blood vessel injury (rare)
  • Scarring
  • Refracture if there is another trauma

Surgeons weigh these risks against the potential benefits of better alignment and faster recovery.

Nonoperative Outcomes

  • Excellent healing rates for nondisplaced or minimally displaced fractures
  • Return to normal activity in 6–12 weeks
  • Minor cosmetic bump may remain but is usually painless

Surgical Outcomes

  • Faster return to sports or physical work in some patients
  • Improved alignment may result in better long-term function in active individuals
  • High union rates (>95%) with modern fixation techniques
  • Long-term outcomes often similar to nonoperative treatment for many fractures

Seek medical care if you experience:

  • Shoulder pain and deformity after a fall or trauma
  • Inability to raise or move the arm
  • Numbness, tingling, or coldness in the arm or hand
  • A “tenting” of the skin or open wound over the clavicle
  • Persistent pain or swelling after treatment begins

Clavicle fractures are common injuries that usually heal well with appropriate treatment. Most can be managed without surgery using a sling, pain control, and rehabilitation. In cases of severe displacement or high activity demands, surgical repair may offer better alignment and faster return to function. With proper care, nearly all patients regain full use of their shoulder and return to normal activities.

At a Glance

Dr. Hasani Swindell

  • Fellowship-Trained Sports Medicine Specialist
  • Board-Certified Orthopedic Surgeon
  • Summa Cum Laude Graduate from the University of Pittsburgh
  • Medical Degree from Columbia University
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