What is a clavicle fracture?
A clavicle fracture is the term for a break in the clavicle bone also known as the collarbone. You have two clavicles that sit between the base of the neck and the upper chest. The role of the clavicle is to connect the arm to the thorax/chest and to protect the top of the lung, the brachial plexus (major nerves) and major arteries. The clavicle connects with the acromion of the scapula forming the acromioclavicular joint, a portion of the shoulder joint and attaches to the sternum In the middle of the chest to form the sternoclavicular joint.
Why and when do clavicle fractures happen?
Clavicle fractures are one of the most common fractures in children and are responsible for up to 5 % of adult fractures. Clavicle fractures are normally the result from traumatic impact to the shoulder or traumatic falls. Falling on your side and directly landing on the shoulder or falling onto an outstretched hand are the most common cause factors. It is instinctive to put your hands out to save yourself when you fall but this means that your hand impacts the hard floor with your body weight behind it. The sudden force and pressure that travels up the arm into clavicle can be great enough to cause a fracture. Due to this clavicle fractures are often seen in contact sports, cycling and in car accidents. A direct blow to the clavicle can also result in a fracture but this is much less common injury mechanism.
What does a clavicle fracture feel like?
A clavicle fracture fromtrauma causes a very intense immediate sharp pain around the fracture site along the top of the chest. The sharp pain often radiates up into the neck, down into the chest and into the arm of the affected side. The fracture is often accompanied by swelling and bruising along the collar bone and in certain cases there will be obvious deformity with a portion of bone lifting the skin up. Due to the fracture the arm will be incredibly painful to use causing the patient to hold or cradle their arm. In the case of children they will refuse to use their arm completely. The intense pain after a break will last for several hours which will be aggravated or prolonged by any treatment options like manipulation or traction. Post-surgery or after treatment when the bone starts to heal there will be a dull continuous ache from the swelling and healing process that will last weeks to months. During the healing process the bone is trying to knit together and re-unite, this stage can be quite painful and it is very important to rest through this stage to ensure that the bone reconnects properly. The soft tissue surrounding the fracture also starts to form scar tissue to bind everything together allowing the structure to try and restore its original state and function.
How will a clavicle fracture be diagnosed?
Patients may be taken to A&E and a full examination will be done to rule out any additional injuries or complications like nerve, arterial or lung damage. Your doctor will order a chest X-ray to confirm the diagnosis and identify the exact location and extent of the fracture. Occasionally if the fracture isn’t fully visible on an X-ray then an MRI or a CT scan will be ordered as this will give a more detailed view of the fractured site. Doctors may also use an MRI scan to assess whether the pain felt after trauma is coming from injury to the nearby acromioclavicular or sternoclavicular joints and not indeed from a fracture. The occurrence of a clavicle fracture from mild trauma may prompt doctors to investigate for any underlying bone weakening conditions like osteoporosis.
What treatments are available for clavicle fractures?
The treatment options and healing times for clavicle fractures vary depending on the position of the fracture and severity of the break and also on the complications from any additional injuries like lung or nerve damage. If a portion of the clavicle has displaced and completely broken away then there is a higher risk of lung, nerve or arterial damage. In these cases doctors opt for surgical fixation to reunite and stabilise the fracture. Traction or manipulation may be used to correct the position of the fractured and dislocated bone and a sling will be used to immobilise the effected arm until the fracture is well healed. In less severe cases the doctor will most likely opt for a conservative treatment using the sling to immobilise the affected arm and instructing patients to rest and avoid using the effected arm completely whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. A clavicle fracture can take anything from 6-8 weeks for an adult and 3-4 weeks for a childto heal if not longer for more severe breaks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen the shoulder and arm to aid the healing process. Fluctuating pain levels will be experienced throughout the healing process however most of the discomfort towards the end of the healing process comes from stiffness levels caused by long term immobility. The rehabilitation exercises as well as massage and some manipulative therapies can aid in recovering your shoulder and arm strength and flexibility.