The Clavicle or Collar Bone is a bony strut that supports and connects the scapula to the rib cage and sternum. The clavicle helps to stabilise the scapula and the entire shoulder joint. A fracture of the clavicle may have an effect upon the mechanics of the shoulder. Fractures most often occur in the middle of the clavicle (mid-shaft). Less often fractures may involve the outer or inner end of the clavicle. The location of the fracture may determine the best treatment options.
Causes of Clavicle Fractures
Fractures of the clavicle typically involve a high degree of force. This might include a direct blow to the shoulder or a fall on to the outstretched arm. Bicycle, motorcycle, and car accidents often result in clavicle fractures. Sporting injuries are also a common cause of clavicle fractures.
Diagnosis of Clavicle Fractures
A fractured clavicle may be obvious just from the clinical appearance of the shoulder. The pain may be severe. There may be a visible deformity or lump at the fracture site. On rare occasions the sharp end of the bone at the fracture site may penetrate the skin. The affected shoulder may droop downwards.
X-rays will help to confirm the diagnosis. X-rays and sometimes CT Scans will also help to monitor the healing process.
Outer End Fracture
Inner End Fracture
Treatment of Clavicle Fractures
Many non-displaced or minimally displaced fractures will unite with non-surgical treatment. They may simply require pain management. Once the surgery pain has eased and healing is seen on X-rays a graduated rehabilitation process can take place.
Some fracture patterns require consideration of surgical fixation to put the fracture fragments in an optimal position for fracture healing. Possible indications for surgery include:
- Fracture angulation
- Fracture displacement
- Fracture shortening
- Fracture Comminution (Fragmentation)
- Clinical Deformity
- Delayed Fracture Union
- Fracture Non-Union
Surgical Treatment of Clavicle Fractures
The location of the fracture, degree of displacement, or fragmentation will determine which technique provides the most secure alignment and fixation of the bone. The most common technique is the application of a plate and screws to the bone. Sometimes a pin within the canal inside the bone will be appropriate. These are technical issues that may sometimes be decided at the time of surgery.
Patients need to understand that surgery does not accelerate the healing process. Surgery sets the scene for the bone to heal in the correct position. The bone still needs to be protected while the knitting process proceeds. A sling may still need to be used temporarily. However a surgical fixation will usually allow a return to light out of sling activities sooner than with a non-surgical treatment. The plate or pin may require removal after the fracture has united.
Plate and Screws
Complications of Clavicle Surgery
Any surgery carries the general risks associated with any surgery. These include the risks associated with a general anaesthetic and infection.
Specific risks related to clavicle fracture surgery include:
- Nerve or Blood Vessel injury
- Delayed or Non-Union of the Fracture
- Local Skin Numbness
- Prominence of the pin or plate
- A Surgical Scar in a visible area
- Mechanical Failure of the fracture fixation