Fractured Clavicle

If you were ever unlucky enough to break a bone, the chances are that it would most likely be your collar bone. Clavicle fractures are the most common type of fracture. The clavicle acts as an important mechanical and functional strut, positioning the shoulder girdle on the chest wall (axial skeleton).

This injury is usually caused by a fall on an outstretched hand or direct impact to the shoulder. Common examples would be a fall off a bike, during a tackle in sport, or landing awkwardly in the surf.

Fortunately, the great majority of midshaft clavicle fractures do not need an operation and will heal by themselves. Treatment involves wearing a sling for 4-6 weeks, and follow-up xrays to ensure the bone has healed. The obvious advantage here is avoiding an operation. Typically, function is excellent with judicious non-operative management. There may be a small “bump” in the region of the healed fracture but this is the trade-off for avoiding a trip to the operating theatre, a general anaesthetic, and a scar!

Some clavicle fractures do require an operation however. The specific indications for fixation are:

• Higher energy injuries – with significant displacement, fragmentation, or shortening
• Lateral clavicle fractures – these have a much higher rate of not healing by themselves due to the mechanics of the shoulder
• Open injuries – where the skin over the fracture is breached or looking threatened
• Multi-trauma patients and the “floating shoulder”
• Associated neurological or vascular compromise

Surgery involves making an incision along the line of the clavicle and then using a plate and screws to achieve a solid fixation. Patients wear a sling for about six weeks by which time the clavicle can be expected to have healed.