Clavicle Fracture (Broken Collarbone)

Also known as: Clavicular fracture, Fracture of the clavicle, Broken clavicle, Broken collar bone, Collarbone fracture, Clavicle break, Fx clavicle

Last updated: December 18, 2024

A clavicle fracture is a partial or complete break of the collarbone, the long bone linking the sternum to the shoulder blade and helping position the shoulder. It most often involves the midshaft but can occur near either end. Pain, tenderness, swelling, and sometimes a visible bump or shoulder asymmetry may occur, often worse with arm movement. Many cases heal with conservative care when displacement is minimal.

Key Facts

•A clavicle fracture describe a partial or complete break in the clavicle, a long bone that connects the sternum to the scapula and helps position the shoulder girdle
•Shoulder or collarbone pain that worsens with arm movement and occurs at rest
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

A clavicle fracture may describe a partial or complete break in the clavicle, a long bone that connects the sternum to the scapula and helps position the shoulder girdle. The injury can involve the midshaft (most common), the lateral (distal) end near the acromioclavicular region, or the medial (proximal) end near the sternoclavicular joint. Fracture patterns can range from nondisplaced cracks to displaced, comminuted breaks that can alter shoulder alignment and biomechanics. Associated soft-tissue injury and, less commonly, nearby neurovascular involvement can occur depending on fracture location and displacement.

Affected Anatomy

This condition affects several structures in and around the joint:

•Clavicle (midshaft/diaphysis)
•Distal clavicle near the acromioclavicular (AC) joint
•Medial clavicle near the sternoclavicular (SC) joint
•Acromioclavicular joint capsule and ligaments
•Coracoclavicular ligaments (conoid and trapezoid)
•Subclavius muscle and clavipectoral fascia
•Brachial plexus elements in the costoclavicular region
•Subclavian artery and subclavian vein adjacent to the clavicle

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Shoulder or collarbone pain that may worsen with arm movement and can occur at rest
•Localized tenderness and swelling over the clavicle that can develop soon after injury
•Visible deformity, bump, or asymmetry of the shoulder girdle that may be more apparent with displaced fractures
•Limited shoulder range of motion that can be due to pain, mechanical limitation, or protective muscle spasm
•Crepitus or a grinding sensation with shoulder motion that may occur when fracture fragments move
•Bruising or skin discoloration over the clavicle and upper chest that can spread over several days
•Arm weakness or difficulty lifting the arm that may reflect pain inhibition or associated soft-tissue injury
•Numbness, tingling, or coolness in the arm or hand that can occur with irritation or compromise of nearby nerves or blood vessels (less common)

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Fall onto the shoulder with the arm adducted, which can transmit force through the clavicle and commonly produces midshaft fractures
•Direct blow to the clavicle or shoulder region during contact sports or collisions, which can cause displaced or comminuted patterns
•Fall onto an outstretched hand, which can transmit force through the upper limb and shoulder girdle to the clavicle
•Motor vehicle or bicycle crashes with high-energy impact, which can be associated with more complex fractures and additional injuries
•Birth-related trauma in newborns, which can occur during difficult deliveries and may present with decreased arm movement

Risk Factors

•Participation in contact or collision sports (e.g., football, hockey, rugby) that can increase exposure to direct shoulder impacts
•Cycling, skiing, or similar activities with higher fall risk and potential high-energy mechanisms
•Adolescence and young adulthood, when sports participation and risk-taking behaviors can be more common
•Older age with reduced bone mineral density, which can increase fracture risk from lower-energy falls
•Osteoporosis or other conditions associated with low bone density, which can predispose to fractures
•History of prior clavicle or shoulder girdle injury, which can be associated with altered biomechanics and reinjury risk
•Occupations or activities involving heights or frequent falls (e.g., ladders, scaffolding), which can increase traumatic exposure
•Inadequate protective equipment use in high-risk sports, which can increase the likelihood of direct impact injuries

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history and mechanism assessment, which can help estimate fracture location, energy of injury, and likelihood of associated injuries
•Physical examination including inspection for deformity, palpation for point tenderness, assessment of shoulder range of motion, and evaluation for skin tenting
•Neurovascular examination of the affected limb, which can include assessment of distal pulses, capillary refill, sensation, and motor function to screen for rare complications
•Plain radiographs (X-rays) of the clavicle and shoulder girdle, which can characterize fracture location, displacement, comminution, and shortening
•Additional radiographic views (e.g., dedicated clavicle views) that can improve visualization of distal or medial fractures and alignment
•Computed tomography (CT), which can be used when fracture complexity, intra-articular extension, or medial clavicle injury is suspected, or when X-rays are limited
•Evaluation for associated injuries (e.g., chest wall injury, rib fractures, pneumothorax) when mechanism suggests higher energy trauma, which can include targeted imaging based on clinical context

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Activity modification and relative rest, which can reduce pain and limit fragment motion during early healing
•Immobilization with a sling or similar support, which can help comfort and may support alignment in many nondisplaced or minimally displaced fractures
•Cold therapy (ice application) in the early period, which can reduce swelling and pain in some cases
•Follow-up imaging to monitor alignment and healing, which can be used when displacement, symptoms, or functional limitations raise concern for delayed union
•Intramedullary fixation techniques, which can be used in selected fracture patterns and may offer smaller incisions in some settings
•Management of complications such as nonunion, malunion, or symptomatic hardware, which can involve additional procedures depending on symptoms and functional impact
•Assessment and management of associated injuries (e.g., chest injury, brachial plexus irritation), which can be relevant in high-energy trauma

Physical Therapy and Exercise

•Physical therapy or guided rehabilitation, which can typically progress from gentle range-of-motion exercises to strengthening as healing advances

Medications

•Analgesic medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), which can be used for symptom control depending on individual factors

Surgery

•Surgical fixation (open reduction and internal fixation with plate and screws), which can be considered for substantially displaced, shortened, comminuted, open, or skin-threatening fractures, or when neurovascular concerns exist

Prognosis and Recovery

The course of this condition varies between individuals:

•Many clavicle fractures can heal with conservative management, particularly when displacement is minimal and soft-tissue injury is limited
•Healing time can vary by age, fracture location, and displacement, and functional recovery can span weeks to months depending on activity demands
•Displaced midshaft fractures can have a higher likelihood of delayed union, nonunion, or residual deformity compared with nondisplaced fractures, although outcomes can still be favorable
•Distal clavicle fractures can have variable stability depending on ligament involvement, which can influence the likelihood of nonunion and the need for operative management
•Some individuals can experience persistent symptoms such as shoulder weakness, fatigue with overhead activity, or cosmetic prominence, particularly with malunion or significant shortening
•Complications such as neurovascular injury or lung injury can occur but are generally uncommon and are more associated with high-energy mechanisms or markedly displaced fractures

Open Reduction and Internal Fixation (ORIF)(Procedure)
Closed Reduction (Fracture Reduction Without Incision)(Procedure)

Frequently Asked Questions

Common symptoms include: Shoulder or collarbone pain that may worsen with arm movement and can occur at rest; Localized tenderness and swelling over the clavicle that can develop soon after injury; Visible deformity, bump, or asymmetry of the shoulder girdle that may be more apparent with displaced fractures; Limited shoulder range of motion that can be due to pain, mechanical limitation, or protective muscle spasm; Crepitus or a grinding sensation with shoulder motion that may occur when fracture fragments move.

Diagnosis typically involves: Clinical history and mechanism assessment, which can help estimate fracture location, energy of injury, and likelihood of associated injuries; Physical examination including inspection for deformity, palpation for point tenderness, assessment of shoulder range of motion, and evaluation for skin tenting; Neurovascular examination of the affected limb, which can include assessment of distal pulses, capillary refill, sensation, and motor function to screen for rare complications; Plain radiographs (X-rays) of the clavicle and shoulder girdle, which can characterize fracture location, displacement, comminution, and shortening.

Treatment options range from conservative measures to surgical interventions, including: Activity modification and relative rest, which can reduce pain and limit fragment motion during early healing; Immobilization with a sling or similar support, which can help comfort and may support alignment in many nondisplaced or minimally displaced fractures; Analgesic medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), which can be used for symptom control depending on individual factors; Cold therapy (ice application) in the early period, which can reduce swelling and pain in some cases; Physical therapy or guided rehabilitation, which can typically progress from gentle range-of-motion exercises to strengthening as healing advances.