The collar bone (clavicle) is an S-shaped bone that connects the sternum (breastbone) to the scapula (shoulder blade bone). Injuries to the clavicle are fairly common and are often easily recognized. The clavicle is the most frequently fractured bone during childhood. Most fractures occur in the middle of the bone.
Fractures of the collar bone most commonly occur with a fall onto the side of the shoulder. Fractures can also be from a direct blow to the clavicle, for instance, if an athlete is hit in the front of the shoulder with a hockey stick or baseball. Less commonly, clavicle fractures may happen with a fall onto an outstretched arm.
Broken collar bones are most common in athletes who participate in football, hockey, and soccer or sports with a high risk of falling, such as biking or horseback riding. Using adequate padding during contact sports and taking measures to prevent falls will reduce the risk.
The doctor will take a detailed history of the injury and examine the shoulder to make the diagnosis. The doctor will also check feeling in the arm and circulation to evaluate for nerve or blood vessel injury related to the fracture. X-rays are obtained to evaluate fracture alignment and position, identify other fractures related to the injury and to confirm proper healing.
Clavicle fractures are often easily recognized. As with any broken bone, affected individuals have immediate pain and may feel or hear a snap or crack at the time of injury. Pain and swelling are common. For most individuals with clavicle fractures, the contour of the fracture on the affected side looks abnormal when compared to the uninjured side. Many individuals with broken collar bones feel more comfortable holding the arm in a cradled position.
Immediate treatment is focused on relieving pain and swelling with icing, rest and pain medication. Holding the arm at the side or cradled by the other arm also often helps relieve pain. Broken collar bones rarely require surgery in younger children who have significant growth remaining. Most clavicle fractures heal very well with minimal treatment. The doctor may prescribe a sling or a shoulder strap for comfort and to keep the ends of the bone from moving.
Clavicle fractures rarely fail to heal on their own, but surgery may be required if:
Surgery may be necessary for a fracture that does not show signs of healing in the first four to six weeks after injury. Surgery should be avoided for purely cosmetic reasons as risks of surgery include infection, poor fracture healing, and prominent scarring.
These fractures generally heal in three to six weeks. There may be a residual bump left at the fracture site after healing is complete. In younger children, the bump tends to resolve over months or years. However, in older children, teens and young adults, the bump may persist. Having a small bump at the site of the fracture does not usually result in pain or difficulty using the arm.
The goal is to return to activity as quickly and safely as possible. Returning to play before full healing puts the patient at risk for re-injury. Determining when to return to activity depends on the location and severity of the clavicle fracture, the amount of healing seen on x-ray and the sport played.
Recovery involves a gradual return to activity. Once the pain subsides, range of motion exercises may begin without the sling to prevent joint stiffness. Once the fracture is healed, there is no tenderness and there is full and painless range of motion of the shoulder with nearly full strength, participation in non-contact sports may begin. This is typically achieved by about six weeks from the time of the injury.
The doctor may delay the return to contact sports for several months, depending on the severity and location of the fracture. Fractures heal very quickly in young children, so kids are often able to return to sports more quickly than adolescents and adults with the same type of injury. For extra protection during contact sports, some athletes may consider using a donut pad or fiberglass shoulder shield worn under the jersey or pads.