break of collarbone

Dr. med. Mira Seidel is a freelance writer for the medical team.

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A broken collarbone (clavicle fracture) is usually caused by a fall on the outstretched hand or the corner of the shoulder. Typical symptoms are movement-dependent pain. Sometimes the broken collarbone is also visible from the outside. In many cases it can be treated conservatively with the help of a special bandage. Surgery is rarely necessary. Find out more about the broken collarbone here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S42

Collarbone fracture: description

The collarbone (clavicle) is the only bony connection between the arm and trunk skeleton. It runs between the breastbone (sternum) and an extension of the shoulder blade (acromion).

The collarbone fracture (clavicle fracture) is one of the most common bone fractures, accounting for three to five percent of all fractures and around 45 percent of all shoulder injuries. Every year, around 64 out of 100,000 people break their collarbones - and the trend is increasing: the change in leisure behavior, in which the trend is towards high-risk sports, is also increasing the frequency of collarbone fractures.

Most often, this type of fracture occurs in people in the third decade of life. The male sex in particular is affected by sports and traffic accidents. For children and the elderly, it is usually a fall on the ground.

Despite its frequency, a broken collarbone is one of the most harmless broken bones. After the fracture of the radius near the wrist (distal radius fracture), this fracture is the second most common fracture in adults.

Collarbone fracture: symptoms

A typical symptom of a broken collarbone is pain. Any attempt to move the arm on that side or chest is extremely painful. Those affected therefore often adopt a protective posture. An audible rubbing sound of the broken bone when moving is also an indication of a fracture.

There is usually a bruise and swelling just above the broken collarbone. If the fracture is postponed, a step in the course of the collarbone can often be seen in slim people - especially when comparing the sides. In the case of obese (adipose) people or those with multiple injuries (multiple trauma patients), however, the step formation is often overlooked.

If there is a fracture in the outer third of the collarbone, what is known as a piano key phenomenon can occur. One end of the break stands up and can be pressed down like a piano key.

Very rarely (in one to two percent of all patients) the collarbone fracture is open, that is, pieces of bone protrude from the skin.

A broken collarbone can also happen during childbirth. The symptoms mentioned above are often less pronounced in the affected babies.

Collarbone fracture: causes and risk factors

A broken collarbone is usually caused by indirect trauma. This includes above all a fall on the shoulder area, in which the collarbone between the shoulder joint and the sternoclavicular joint (sternum-clavicle joint or medial clavicle joint - the articulated connection between the sternum and collarbone) is subjected to bending stress.

A less common cause is falling on the outstretched hand, for example while inline skating or cycling. In fact, a broken collarbone is the most common type of broken bone among cyclists.

More rarely, direct trauma from a blow or fall to the front shoulder is the reason for a broken collarbone. In a motorcycle accident, the collarbone can break if the lower edge of the motorcycle helmet is pressed against the clavicle.

In the case of indirect trauma, the collarbone usually breaks in the middle (90 percent) and in the case of direct trauma, it usually breaks in the outer third of the bone.

Occasionally, a broken collarbone occurs in the newborn during childbirth, namely when the child's shoulder girdle is constricted as it passes through the maternal pelvis. This is particularly common in large babies.

Collarbone fracture: examinations and diagnosis

If you suspect a broken collarbone, you should see a doctor specializing in orthopedics and trauma surgery. He will first ask you exactly how the accident happened and your medical history (anamnesis). Some questions from the doctor might include:

• Have you fallen on your shoulder or an outstretched hand?
• How did the accident go exactly?
• Can you still move your shoulder or arm?
• Do you have pain?
• Have you already had symptoms such as pain, restricted mobility or a previous dislocation of the shoulder?

The description of how the accident happened and the symptoms are often enough for the doctor to consider a broken collarbone. It becomes more difficult when the patient is unconscious due to multiple injuries (multiple trauma) and other injuries are initially in the foreground.

Physical examination

A more detailed examination is necessary to clarify the suspected diagnosis of a broken collarbone. The doctor examines the shoulder joint (acromioclavicular joint) and the sternum-clavicle joint (sternoclavicular joint). He carefully tests the mobility of the shoulder and arm and pays attention to tenderness. Blood flow and sensitivity in the affected arm are also checked.

It is also important to rule out accompanying injuries such as a pneumothorax (air entry into the pleural space). This is possible through auscultation (listening) to the lungs.

Imaging procedures

This is usually followed by an X-ray examination in different planes. This makes it possible to clarify with certainty whether there is a broken collarbone, where exactly the break line runs and how serious the injury is. If it is unclear whether other joints are affected, images of the shoulder joint, the sternum-collarbone joint and the chest are taken. An ultrasound examination of the shoulder and the ankle joint can be useful for further clarification.

Mid-range clavicle fractures can sometimes not be assessed by an x-ray alone. In this case, computed tomography (CT) may be necessary. A CT is usually made even for severely injured, polytrauma patients.

Accompanying injuries to a broken collarbone, such as capsular ligament injuries to the shoulder, can be assessed using magnetic resonance imaging (magnetic resonance imaging, MRI).

In infants, the pediatrician recognizes a broken collarbone based on the relieving posture and palpation of the collarbone. X-rays are rarely taken of babies.

Collarbone fracture: treatment

Treatment of a broken collarbone aims to relieve pain and restore resilient and stable bone at an early stage. Depending on the type of fracture, it can be treated conservatively or surgically.

Collarbone fracture: conservative treatment

About 90 percent of all broken collarbones can be successfully treated conservatively. The patient is first given pain medication and the affected side is immobilized with a backpack or sling bandage:

The rucksack bandage is applied to the middle and middle third of the collarbone in the event of a break. Regular checks must be carried out to ensure that the dressing is correctly positioned, otherwise there is a risk that the fragments will be displaced. As a rule, adults have to wear the backpack bandage for three to four weeks and children for ten days. After six weeks, free and pain-free mobility in the shoulder joint should be possible.

In the event of a fracture in the lateral third of the collarbone, a Gilchrist bandage (sling bandage) is applied.

This conservative treatment using a rucksack or sling bandage is particularly suitable for a broken collarbone that is not shortened and has little or no displacement. Pain and mobility of the shoulder and arm provide information about the success of the treatment.

If after three to four weeks there is still a painful instability of the fracture, this indicates impaired bone healing. After 12 weeks without bony callus formation one speaks of delayed healing, which leads to pseudarthrosis (false joint) in about 50 percent of cases.

Collarbone fracture: surgery

A broken collarbone operation can be considered in the following cases:

• postponed break
• Break with intermediate fragment (z-shaped switching fragment)
• Multiple injuries (multiple trauma)
• open fracture
• Fracture with additional vascular and nerve injuries
• bilateral clavicle fracture
• painful pseudarthrosis

All in all, a broken collarbone is now operated on more often in order to achieve a secure fracture position.

Nails, plates, wires

In the case of a broken collarbone with two fragments, nails such as Prevot or TEN (Titanic-elastic-nail) nails are used. For more complex fracture shapes that have more than two fragments, angle-stable or non-angle-stable plate systems are used. If there is a broken collarbone in the outer third of the bone, Kirschner wires (flexible wire) with cerclage (thread or wire) or, in special cases, a hook plate can be used.

After the operation

After the collarbone fracture operation, the patient is usually given pain relievers such as paracetamol or ibuprofen. An arm sling is put on to protect the arm.

The shoulder joint should then only be moved gently up to a maximum of the horizontal plane for six weeks. Sports that put pressure on the shoulders may only be practiced after the X-ray check, when stable bone has been proven. However, this should begin after twelve weeks at the earliest.

Collarbone fracture in children

In children it is usually a closed shaft fracture. It is treated with the arm sling for small children and with the rucksack bandage for older children. If the outer third of the collarbone is injured, open surgery may be necessary. The break is temporarily stabilized with a Kirschner wire.

Collarbone fracture: disease course and prognosis

A broken collarbone generally has a good prognosis. However, patients often underestimate how much mobility is restricted by the fracture.

Collarbone fracture: complications

The following complications can occur with a collarbone fracture:

• Failure of bone healing
• Bone cannot be realigned
• Shortening of the collarbone
• pains
• Swelling in the arm
• Pins and needles (tingling paresthesia)
• The arm and shoulder cannot be moved as they were originally

An operation is always associated with certain risks, such as inflammation. However, these rarely occur. The following complications can arise in connection with the operation:

• Wound healing disorders
• infection
• Implant fails, breaks, or drifts
• Scarring
• Sensory disturbances

Collarbone fracture: healing time

The duration and course of healing in a collarbone fracture vary depending on the type of fracture.

With conservative treatment of a broken collarbone, the prognosis is usually very good. A slight shortening or misalignment of the collarbone after the end of therapy usually does not have a negative effect on the function of the shoulder joint.

After about three weeks, you can raise your arm to the horizontal. After six weeks at the earliest, a callus (newly formed bone tissue) is visible on the X-ray control. At this point you should have almost completely free mobility and should be largely free of pain. However, you should only resume sports that put strain on the shoulder after the twelfth week.

With surgical therapy, the patient is usually fully resilient again a little faster. An inserted implant is removed again after three months at the earliest. In the case of severe fractures, you should wait at least six months, even if the healing process is uncomplicated.

In the long term, less than optimal aesthetic or functional results are achieved in 30 percent of those affected with a broken collarbone.

In children, a broken collarbone usually heals after four weeks, with a strong callus forming. The bone then rebuilds itself over the years. A broken collarbone that occurs at birth usually heals without complications.

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