Broken Collarbone (Clavicle Fracture)

What is a broken collarbone (clavicle fracture)?

Clavicle Bone Fracture

A broken collarbone (fractured clavicle) is an injury that typically happens if you fall and then try to break your fall by putting your arm out. A big force goes up the arm, and across the shoulder, breaking the collarbone, and it’s a common injury in mountain bikers, horse riders, skiers and rugby players.

If you’ve broken your collarbone, you’ll know its really painful…

What are the symptoms or signs of a broken collar bone?

The moment you fracture your collar bone, you’ll feel pain and it will very difficult to move your arm.

You might see a bump or swelling along the collar bone, and perhaps some bruising or even a crunching sensation if you try to move your arm.

You may notice that your shoulder is sitting in a poor position, or even experience pins and needles in your arm.

How is a broken collar bone assessed?

If you suspect that you’ve broken your collarbone, it’s important to seek urgent assessment at an accident and emergency unit. You’ll typically be examined, have an X-ray, and decision will be made about whether surgery urgently needs to take place (e.g. if piece of bone might be about to pierce through the skin, or if there’s risk of damage to important nerves or blood vessels).

You may be discharged from A and E with a sling, painkillers and possible follow up in fracture clinic, but you may wish to consider coming to see me instead.

This is the time can I best help you, particularly if the best way to proceed isn’t very straight forwards, or if you’ve been potentially offered surgery.

As an expert in shoulder surgery, I can give you very tailored advice, and if needed, surgical treatment within the private healthcare setting.  Fractures start to heal within a week, so it’s really important you book in urgently to see me. I’ll do my very best to see you as swiftly as possible.

When you come to clinic, I’ll be asking you lots of questions about how the injury happened, your symptoms, and what’s important for you in life in terms of work, family commitments and any sporting activities.

I’ll likely recommend some X-rays to assess the fracture, but sometimes a CT or MRI scan may additionally be needed to give us a deeper assessment.

CLAVICLE FRACTURE

What’s the treatment for a collarbone fracture?

Most collarbones injuries tend occur in the middle third of the collarbone, and if the bone ends are in good alignment, the collarbone is 85 % likely to heal without the need for surgery.

To get the best outcome, you need to be patient and use a sling to support the weight of your arm for 4-6 weeks to allow the bone ends to heal. You will need to wear the sling at all times except when you’re washing your body, or doing some very gentle physio exercises to help prevent stiffening.

Whilst a sling is good at supporting your arm, it may not allow the bones to heal in an optimal position. An even better option is to be fitted with a “Clavibrace”.

The Clavibrace is a tight waist coat that has specialised padding, reinforced with struts. It’s designed specifically to bring the bone fragments back into excellent alignment.

I’m one of the very few London Shoulder Surgeons who are trained to fit the Clavibrace.

By four weeks, most people are able to spend some time out of the brace intermittently during the day, and it can be removed completely at 6 weeks. X-rays will be taken to ensure the healing is progressing well.

Physiotherapy is very important to restore and restrengthen the normal shoulder movements, and you could potentially aim to return to sports at around the 3-4 months stage.

When does a broken collar bone need surgery?

Most fractured collar bones will heal well without surgery, but there are few instances when surgery may be the better option:

  • If a collar bone breaks in a way that it’s in several pieces (known as a comminuted fracture), or the bones are very displaced.

  • If the broken ends overlap (e.g. by >2cm), which can lead to long-term shortening of the collar bone and future shoulder and neck pain.

  • If the fracture has led to some rotation along the length of the collarbone.

  • If conservative treatment isn’t succeeding, or the pain isn’t settling.

  • If there’s any risk to the skin overlying the fracture (because of a sharp, bony fragment), or nerves or blood vessels potentially being damaged, then surgery is needed

  • If there’s a big risk of poor healing (e.g. if you have low bone mineral density, diabetes, or if you’re a heavy smoker).

  • If the fracture occurs towards the outer (lateral) end of the collarbone, or if there is additional damage to the ligaments supporting the collarbone (coracoclavicular ligaments).

What happens during surgery for a broken collarbone?

Surgery to repair your broken collarbone will usually happen as a day case procedure, which means you come into hospital in the morning, and go home by the end of the day. Occasionally, an overnight stay may be needed if surgery is carried out later in the day.

You’ll have a light general anaesthetic, and what’s called a nerve block, which helps numb the area, ensuring you’re pain free after the operation.

During the operation, I make an incision over the area where the collarbone is broken, and I clear any debris or damaged tissue. I fix the ends of collarbone into their correct position, so they’re in good alignment. I secure them in place using a slender metal plate and screws.

I’m really fussy about the neatness of the skin closure, and I want you to have the best cosmetic outcome possible.

Having surgery won’t speed up the time of getting you back to being fully active (you can’t cheat the healing process), but it’s likely to get you feeling comfortable much more quickly.

We’ll meet again in clinic at 10 days to remove the dressings and then again at 6 weeks. X-rays will be taken to make sure all is going well, you’re healing, and the alignment is excellent. Physiotherapy will be needed to get you back to moving well.

You may be wondering when you could expect to return to sport. Whilst everyone is an individual and recoveries differ, you may need to allow 3-4 months before returning to contact sport.

What are the risks of having surgery for a broken collarbone?

What are the risks of having surgery for a broken collarbone?

Thankfully, poor outcomes from surgery are rare. For instance, the risk of getting an infection is less than 1%.  In theory there is a very small potential risk of damage to nerves or blood vessels – again very rare. The nerves that supply the skin on the upper part of the chest wall are very small and must be divided to access the fracture site, so you may have an area of numbness in this region. Most patients are not bothered by this at all.

It is possible that the healing might be delayed or happen in a poor position, or not at all, and in these very unusual situations there is still plenty that can help rectify the situation.

I’m often asked, is it necessary to remove the metalwork after the fracture surgery? As a rule of thumb, we typically leave the metalwork undisturbed. Very occasionally, if the metal work were to cause irritation, e.g. because of the sensation of a screw under the skin, we might choose to take it out, but only after several months has passed the fracture had fully healed.

Post surgery FAQ

Don’t rush back to work; try to take off at least a week.

It’s important to use the keyboard with your forearms supported on the desk. Wait till you’re comfortable and don’t overdo it?

Yes, unless you’ve had surgery for a frozen shoulder, or shoulder impingement surgery – in which case, you can take it in and out, as comfort allows.

Avoid baths until the dressings have been removed – typically at 10 days. Your wounds will have waterproof dressings on, so it’s ok to take a shower. It’s really important to keep your arm pits clean – so have a good scrub with a flannel!

Make sure that your hand is above the level of your elbow, so that your arm is completely relaxed in the sling

For the first three to four days, don’t wait for the pain to kick in, take them regularly (even if you’re not feeling pain – we want to keep it at bay).

Yes.

Lying flat can be painful, so try propping yourself up on several pillows.

You can sit on a stationary bike straight away (as long as you keep your arm in your sling). You’ll be given more detailed instructions about other activities, when you are seen in clinic.

My secretary will arrange a follow up appointment approximately 10 days after surgery. At this appointment, I’ll remove your dressings, and check that the wound is OK. If you’ve had surgery for a fracture or joint replacement, we may need take an X-ray.

Ms Susan Alexander is recognised by all the UK’s major insurers