Dr. Terrell Joseph
How Do Clavicle Fractures Happen?
Recently, a very pleasant gentleman came into the clinic almost two months after falling off his bicycle and fracturing his clavicle. He was out of the area at the time and was treated by an orthopeadic surgeon nearby.
He was originally told the fracture wasn’t bad enough to need surgery, and if supported, his fracture would heal on its own in 6-8 weeks. Unfortunately, the fracture did not heal and required surgery.
This is called a “non-union,” and it can happen to the best of us. (More on this in a future post) Fortunately, this is not the common storyline after a clavicle fracture.
WHAT IS THE CLAVICLE?
The clavicle is the technical term for your collarbone. It is an S-shaped long bone that is the strut supporting the arm from the sternum and shoulder blade. There are several crucial nerves, blood vessels, and other structures that are beneath it.
Most often, a clavicle fracture doesn’t damage these. It is easy to palpate the clavicle as it is very prominent in the front of the shoulder and chest. It is also easily visualized in most patients without a shirt on.
HOW DO CLAVICAL FRACTURES HAPPEN?
A clavicle fracture can happen in a couple of ways. Most commonly, it happens when a person falls on the tip of their shoulder. There can also be a fracture if the clavicle takes a direct blow. The site of the fracture is usually in the middle, or the “midshaft.” Our patient from earlier had his fracture here.
This is where it is weakest, at the middle of the curve. There can also be a fracture at the distal end, where it attaches to the shoulder, and the proximal end, where it attaches to the sternum. Occasionally, the fracture can be bad enough to “tent” the skin. This means that one of the ends of the fracture has been pushed up and the skin is being bulged upward.
HOW DO YOU KNOW YOU HAVE A CLAVICLE FRACTURE?
An x-ray will give the answer. The clavicle is easily seen on an x-ray and doesn’t require more imaging. From the x-ray, we can determine if the fracture is able to be treated conservatively or will require more attention.
WHAT’S THE TREATMENT FOR A CLAVICLE FRACTURE?
Like any other injury, conservative treatment is most desirable. If the fracture is well aligned, a sling is all that is needed. It’ll be worn for 6-8 weeks to support the arm and allow the bone to mend. Every few weeks, an x-ray will be taken to check on the healing.
If the fracture is displaced, the two ends are more than 15mm apart; this will require surgery. An ORIF with a plate and screws will put the clavicle back into alignment. After surgery, patients always say there is an almost immediate improvement in pain and function.
They can get back quicker to light day to day use right after surgery. The arm will be supported by a sling for comfort for up to 6 weeks. More x-rays will be taken and the sling can be discontinued when the fracture is healed.
CLAVICLE FRACTURES CAN HAPPEN TO ANYONE
Clavicle fractures can happen to anyone. Top-level athletes (i.e. Aaron Rodgers of the Packers) or your average active person (like our gentleman from out of town) can both be impacted by this very common injury.