Broken Collarbones

The collarbone, or clavicle is a bone which helps to support the shoulder blade (scapula) and upper limb. It is the only bone that connects the upper limb to the chest wall (or axial skeleton). The clavicle acts as a strut that keeps the shoulder a set distance from the midline of the body. The collarbone is the most commonly fractured bone in the body. Fractured clavicles occur with a fall onto the hand, elbow or shoulder. When a fracture clavicle is in good position (non-displaced) it may be treated non-operatively. This involves supporting the shoulder in a sling for approximately 4 weeks and only performing elbow, wrist and hand exercises, and then gradually commencing range of motion exercises as then pain begins to settle down.

Displaced fractures can also be treated non-operatively.

A small percentage of fractures treated non-operatively may not heal (non-union). If pain persists this may require open non-union debridement, bone grafting to re-stimulate the healing process and internal fixation with plate and screws.

There are some situations when a fractured clavicle should be fixed semi-urgently:

• If the skin has been breached adjacent to the fracture (i.e. the fracture is open or "compound")
• If there is neurological or vascular compromise
• If the skin is "threatened" because of pressure from the bone fragments
• If there is an associated fracture of the shoulder blade as well ( floating shoulder)
• If there are multiple fragments and/or the fracture is shortened by 2cm or more

The traditional treatment for a displaced midshaft fracture of the clavicle was non-operative as described above. Recently however, a Level 1 study* demonstrated numerous advantages to treating these fractures with an operation to fix the bone. The main advantages of an operation reported in this study were:

• A lower risk of the bone not healing (non-union) properly. (15% versus 1.6%)
• Improved function of the arm with an operation
• A better body image

These advantages of an operation must be weighed against the risks of the operation to allow an informed choice on behalf of the patient. Risks of clavicle surgery include but are not limited to infection, skin nerve injury, brachial plexus or vascular injury and delayed implant removal for irritation.

*Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures: A Multicenter, Randomized Clinical Trial; Canadian Orthopaedic Trauma Society The Journal of Bone and Joint Surgery (American). 2007;89:1-10.