Broken Collarbone (Clavicle Fracture)

Hard falls and collisions are a reality of sports, and they often lead to injuries. Taking a spill and falling on a shoulder or with arms outstretched puts tremendous stress on the shoulder and on a small bone called the clavicle, or collarbone. If the stress is too great, the collarbone can break.

Broken collarbones are one of the most common sports injuries among kids and teens.

About Broken Collarbones

The collarbone runs between the top of the breastbone (sternum) and the shoulder blade (scapula) and helps connect the arm to the rest of the body. You can feel your collarbone by touching the area between your neck and your shoulder. Most people can see their collarbones sticking out beneath the skin when they look in the mirror.

A broken collarbone typically is the result of a direct blow to the shoulder or a fall onto an outstretched arm. Collarbone breaks (fractures) are common in contact sports (like football, lacrosse, and hockey) and in sports where there is a chance of a hard fall (such as biking, skiing, snowboarding, and skateboarding). They also can follow direct trauma to the collarbone during a car collision or other accident.

Most collarbone fractures will heal on their own if the arm is properly immobilized in a sling and the injury is treated with ice and physical therapy. Sometimes, however, if the collarbone is significantly displaced or the break is severe, surgery may be needed to realign the bone, with screws and plates inserted to hold the collarbone in place as it heals.

Symptoms

If your child has a broken collarbone, the most obvious symptoms will be pain in the affected area and difficulty moving the affected arm. Other symptoms include:

• swelling, tenderness, and bruising along the collarbone
• increased pain when your child tries to move the shoulder or arm
• feeling a grinding or crackling sensation if trying to raise the arm
• a bulge or deformity above the break (in rare cases, the broken end of the bone may even penetrate the skin and be exposed)
• slumping or sagging of your child’s shoulder down and forward

Diagnosis

To diagnose a collarbone fracture, a doctor will ask about the injury and what symptoms your child has. The doctor will examine your child’s shoulder and may press gently on the collarbone to see if it is tender, determine where the fracture is, and make sure no nerves or blood vessels are damaged. The doctor might check the feeling and strength in your child’s arm, hand, and fingers to see if there is nerve damage.

If a broken collarbone seems likely, the doctor will order X-rays of the shoulder and the affected area to pinpoint the location of the break and check its severity. X-rays also show if any other bones are broken. In some cases, if other bones are broken or if the doctor needs to see the fracture in greater detail, a computerized tomography (CT) scan will be performed.

Causes

Most collarbone fractures are due to a fall onto the shoulder, but they can also follow a fall onto an outstretched hand or a direct blow to the collarbone itself (as from a sports-related injury or car accident). Newborns also can incur a broken collarbone as they pass through the birth canal.

In a collarbone fracture, the break can happen in three areas of the collarbone:

1. Most occur in the middle third of the bone, generally from a hard fall or direct impact to the middle of the collarbone.
2. A fall or impact that transmits force to the outside or top of the shoulder can cause a fracture on the outer third of the collarbone, the part closest to the shoulder itself.
3. The rarest type of collarbone fracture happens on the inner third of the collarbone. These are almost always the result of a direct blow to the front of the chest, such as from an impact with a steering wheel during a car collision.

Risk factors that can increase the chances of a collarbone fracture include:

• Participating in sports that involve contact or the possibility of a hard fall. Injuries related to sports are perhaps the most common cause of collarbone fractures. There’s a risk of hard falls in sports from skiing to soccer and wrestling, and from contact sports like football, hockey, rugby, and lacrosse.
• Age. Bones that are still growing are more susceptible to injury. Collarbones typically don’t harden completely until someone is about 20 years old, putting those who are younger at greater risk of a fracture. The risk goes down after the teen years but increases again as people age and their bones begin to lose strength.
• High birth weight. Having a high birth weight can make a baby more at risk for a collarbone fracture during labor and delivery.

Prevention

Because they happen suddenly and unexpectedly, collarbone fractures can be hard to prevent, but a few precautions can help kids decrease their risk:

• Make sure your kids wear all the recommended protective gear needed for sports, and help them to learn the proper techniques. Knowing the right way to play decreases the chances of an awkward fall or unexpected blow.
• Keep your kids’ bones strong by offering a diet rich in calcium and vitamin D. Foods like milk, cheese, and yogurt can help build strong bones that are less likely to break during an impact.
• Encourage strength training and stretching to build strong, flexible muscles. Muscles that are strong and flexible help support bones better and keep kids agile and less likely to take a hard fall.
• Take steps to prevent falls. Make sure your kids wear supportive footwear, teach them to use handrails when coming down stairs, and keep your home well lit.

Treatment

Treatment for a collarbone fracture depends upon the type of fracture and how severe it is. Most fractures can be treated with simple comfort measures until they heal.

But fractures where bone fragments on each side of the break are severely shifted (displaced fractures) or where the bone is broken into several pieces (comminuted fractures) may require surgery for proper healing. Compound fractures, where the broken bone pierces the skin, require immediate, aggressive treatment to reduce the risk of an infection.

For fractures where the bone fragments stay aligned, these treatments are recommended:

• Ice. To help control the pain and swelling associated with a collarbone fracture, apply wrapped ice packs to the affected area for the first 2-3 days after the injury. Be careful not to apply ice directly to the skin, though, as this can injure it.
• Arm support. Following a collarbone fracture, it’s important to keep the arm immobilized by using a sling or wrap. This will help control the pain and keep the bone in position as it heals.
• Medication. Talk with the doctor about which medicines (such as ibuprofen or acetaminophen) your child can take to help manage pain.
• Physical therapy. While your child’s arm is immobilized, it’s likely to lose muscle strength and range of motion in the shoulder will decrease. Once the bones have started to heal, your child should begin gentle motion exercises to reduce stiffness while still wearing the sling. When the bone has healed completely, the doctor may recommend a more strenuous rehabilitation program to help rebuild the shoulder’s strength and flexibility.

The special screws and metal plates used when a significantly displaced, compound, or comminuted fracture requires surgery won’t need to be removed once the bone has healed unless they cause irritation.

After surgery, doctors will often prescribe a therapy routine to help restore movement and strengthen the shoulder. Usually, therapy will start with gentle motion exercises, and strengthening exercises will be added as the bone heals.

For younger children, healing time can be as fast as 3-4 weeks. For teens, healing time is usually about 6-8 weeks. During this time, your child should take it easy to reduce the risk of reinjuring the bone. After that, follow up with the doctor about when your child can return to normal activities.