Clavicle Fractures

A clavicle fracture is a common injury, ranging from a simple fracture to more serious highly unstable fracture patterns. A non-displaced fracture of the clavicle is a crack in the bone, but the bone keeps its position and alignment. When the clavicle breaks in two or more pieces and is out of alignment it is called a displaced fracture.  When the clavicle breaks it may be an isolated injury or involve damage to soft tissues such as nerves, muscles, tendons and ligaments. A majority of clavicle fractures occur in the middle of the bone.

Clavicle fractures are commonly caused by high energy trauma, a direct blow or impact to the shoulder area, such as falling onto the shoulder or an outstretched arm during a noncontact sport such as skateboarding, bicycling and horseback riding or a motor vehicle accident. Athletes can also experience a clavicle fracture from a collision during contact sports such as football, hockey and soccer, and other types of trauma. Older people with osteoporosis can suffer a clavicle fracture from low energy falls.

The most common symptoms of clavicle fractures include:

• moderate to severe pain
• swelling, tenderness and bruising at the site of the fracture
• a bump above the break
• a sagging shoulder
• difficult or painful movement when attempting to lift the arm
• instability in the joint
• an audible crack or snap at the time of injury
• a grinding sensation when lifting the arm

Dr. Petrigliano will inquire about the injury and your symptoms. He will perform an orthopedic evaluation testing for pain and tenderness, palpating to identify the location of the break and to determine the severity of the fracture. He will spend time assessing the soft tissues including blood vessels and nerves to ensure damage is discovered. He will order imaging tests such as X-rays and CT scans to confirm his diagnosis and identify any related injuries that may need to be addressed. With all this information he will confirm his diagnosis and discuss treatment options with you.

Treatment for a clavicle fracture depends on the severity and location of the injury. Dr. Petrigiliano is always sensitive to the needs of each patient and their activity levels when he considers their treatment options.

If the broken pieces are in alignment, the break can heal with nonsurgical treatment including a sling or splint to protect and support the arm while it heals, pain medication and physical therapy to maintain movement and prevent stiffness and weakness. Once the break heals, more active physical therapy will help regain strength and stability in the shoulder.

If the fracture fails to heal it is called a nonunion. If there is little pain and good motion no other treatment may be needed.

The aim of surgery is to repair the damaged bone and restore stability.

• When the patient continues to suffer significant pain after nonsurgical treatment surgery will be recommended.
• When the bone pieces heal out of alignment whether surgery is necessary depends on how it impacts the ability to use the arm.
• When the broken pieces are out of place surgery will be needed.

Surgery may involve open reduction and internal fixation (ORIF). This is the most common surgery to treat clavicle fractures when the break is out of alignment and there are broken pieces of bone. Additionally, if the fracture is an open fracture that breaks the skin, ORIF is the best surgical option.

During ORIF the bone pieces are repositioned and put into normal alignment and are held in place with metal screws and plates. If there is damage to soft tissues, blood vessels or nerves these will be repaired during ORIF. ORIF is a safe and reliable procedure with good early functional recovery.

After surgery your pain will be managed with over the counter and prescription pain medication, icing.  Post op rehabilitation is essential to restore strength and function.

In some cases, minimally invasive techniques such as arthroscopy may be available. If the break is a complex unstable distal clavicle fracture with a rupture of ligaments it can result in delayed union of the bones or nonunion. There is no standard treatment. Yet, Dr. Petrigliano is a sports medicine specialist and an orthopedic surgeon. He is up to date on the newest arthroscopic and open surgical procedures available to treat a clavicle fracture and will recommend the best options for each patient.