A clavicle fracture is typically associated with extreme pain, and arm movement is difficult.

Clavicle Fracture Signs and Symptoms

A clavicle fracture is typically associated with extreme pain, and arm movement is difficult. The clavicle bone lies just beneath the skin, so a fracture usually causes an obvious protrusion or bump at the fracture site, along with swelling. (While the bump will diminish over time, a small bump may remain after the fracture heals.)

Other symptoms include:

  • Sharp pain felt at the time of injury; the injured person may feel pain when trying to move the arm.
  • Stiffness in the shoulder that makes shoulder movement difficult or impossible.
  • The affected shoulder sags, forward or downward.
  • Swelling, tenderness, and bruising occur over the collarbone.
  • A grinding sensation when trying to lift the arm.
  • The desire to hold the affected arm close to the body supporting it with the hand of the healthy arm.

If a clavicle break is suspected because of a traumatic-related event, other injuries may be present. If possible, bystanders are advised to wait for medical personnel to move the injured person. Occasionally, a person with a broken collarbone also experiences labored breathing, which may be a sign of an injured lung. Lung injuries are associated with clavicle fractures.

Conservative treatment

Conservative or non-surgical treatment is the norm for middle-third clavicle fractures, and is recommended for not displaced fractures given the generally low incidence of non-union after conservative treatment of these fractures with rates ranging from 0.03% to 5.9%. There are numerous conservative treatment options available, the most common being the use of a sling or figure-of-eight bandage (also known as figure-of-eight splint, or back-pack bandage), or a combination of these two methods. There appears to be no consensus on the optimal duration of immobilization; some have recommended two to six weeks. Often no subsequent therapy is suggested to the patient. Sometimes, however, a patient will require stretching exercises to regain motion. We prefer to follow the patient with a structured rehabilitation in order to have a satisfactory outcome for most patients. To protect the healing clavicle, it is important to avoid contact sports for a minimum of 4 to 5 months.

Recent studies on displaced midshaft clavicular fractures indicate a significant unmet medical need, with non-union rates of 15% and unsatisfactory patient-reported outcomes in around a third of patients (15;21). These findings have prompted a recent increase in surgical fixation of displaced fractures. The comparison of surgery versus conservative treatment is the subject of a forthcoming Cochrane review.

Surgical treatment

Different surgical treatments are reported in literature liked by different type of fractures and injury. Surgical treatment of medial-end clavicle fractures is indicated if mediastinal structures are placed at risk because of fracture displacement, in case of soft-tissue compromise, or when multiple trauma and/or floating shoulder injuries are present. Closed or open reduction should be performed to reduce the displaced fragment in an emergent fashion. When open reduction is necessary, several techniques have been described for internal fixation of fracture fragments. These include wire or plate fixation and interosseous sutures. In general, Kirschner wire fixation has proven unsafe because of breakage and migration. By contrast, use of interosseous wires or suture and modified hooked Balser plate fixation appears more successful but requires a second operation for hardware removal. Most injuries in children and adolescents involving the medial end of the clavicle consist of epiphyseal separations. This is because the medial epiphysis of the clavicle does not ossify until age 20 years and ossification centers rarely fuse before age 25 years. It is important, however, to differentiate epiphyseal separations from true sterno-clavicular joint dislocations because of the remodeling potential and because the treatment of these 2 diagnoses can differ greatly. A computed tomography scan can be helpful to distinguish these entities.

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