Clavicle Fracture and Broken Collarbone Treatment
The collarbone sits directly under the skin with almost nothing protecting it, which is why it breaks so often and why the break is usually obvious. Patients can generally feel the step in the bone through the skin, and many arrive already knowing what happened. What they do not know, and what actually matters, is whether it needs surgery.
The answer for most clavicle fractures is no. Steven Struhl, MD has practiced in New York since 1991, is board certified in orthopedic surgery and separately in sports medicine, and is a Fellow of the American Academy of Orthopaedic Surgeons. He treats shoulder fractures at offices in Manhattan and White Plains.
What Causes a Clavicle Fracture
The mechanism is nearly always a direct blow to the shoulder or a fall onto it, the same mechanism that produces an AC joint separation, which is why the two are sometimes confused on a first examination and occasionally occur together.
- Falls Onto The Shoulder: landing on the point of the shoulder rather than an outstretched hand.
- Cycling Accidents: going over the handlebars, the most common cause in adults.
- Contact Sports: direct impact in football, hockey, rugby, and similar sports.
- Birth Injury: the most commonly fractured bone during delivery, and one that heals reliably.
Clavicle Fracture Symptoms
- Immediate Sharp Pain: pain at the collarbone that worsens with any attempt to lift the arm.
- A Visible Deformity: a bump or step where the fracture ends have shifted out of line.
- Swelling And Bruising: discoloration developing over the collarbone within the first days.
- A Sagging Shoulder: the shoulder drops forward and downward without the strut of the collarbone.
- Grinding With Motion: a crackling sensation as the fracture ends move against each other.
Clavicle Fracture Treatment Without Surgery
Most clavicle fractures heal well without an operation, and the treatment is simpler than patients expect.
- Sling Immobilization: supporting the arm for several weeks while the bone begins to unite.
- Pain Management: medication during the early weeks when discomfort is most significant.
- Progressive Motion: gentle range of motion work introduced as healing allows.
- Strengthening: restoring shoulder and scapular strength once the fracture has united.
When a Broken Collarbone Requires Surgery
- Significant Displacement: fracture ends shifted well out of alignment or overlapping.
- Shortening: the bone healing short enough to change shoulder mechanics and strength.
- Skin Tenting: a fragment pressing against the skin hard enough to threaten it.
- Open Fracture: bone that has broken through the skin, requiring urgent treatment.
- Multiple Fragments: severely comminuted fractures unlikely to align on their own.
- Nonunion: a fracture that has failed to heal after an appropriate period.
Surgical fixation typically uses a plate and screws to hold the fracture in correct alignment while it heals, which restores length and alignment more reliably than a sling can in a displaced fracture.
Dr. Struhl frames the decision around what the shoulder is being asked to do afterward, noting that “the things you love to do aren’t just the causes of your injury: they’re the things you want to get back to.” – Steven Struhl, MD, Board Certified Orthopedic Surgeon
Frequently Asked Questions About Clavicle Fractures
- Most adult clavicle fractures unite over roughly six to twelve weeks, with children healing considerably faster. Bone union and full function are different milestones, and restoring strength and motion often continues for a period after the fracture itself has healed.
- Usually not. The majority heal well in a sling. Surgery is considered when the fracture ends are significantly displaced or shortened, when a fragment threatens the skin, when the bone has broken through the skin, or when a fracture has failed to unite.
- Frequently yes, and it is usually permanent. As the fracture heals the body forms a callus of new bone at the site, and in a bone sitting directly under the skin that callus is often visible. It is a cosmetic finding rather than a functional problem.
- Not while you are dependent on the sling and unable to control the wheel safely with both arms. Most patients resume driving once the sling is discontinued and the arm moves comfortably, which is typically several weeks in.
- A nonunion causes ongoing pain, a sensation of movement at the fracture site, and weakness. It is treated surgically, generally with plate fixation and often with a bone graft to stimulate healing, and results after treatment are usually good.
- No, though the mechanism and the visible bump can look similar. A clavicle fracture is a break in the bone itself. An AC joint separation is a tearing of the ligaments where the collarbone meets the shoulder blade, with the bone intact.
Schedule a Clavicle Fracture Evaluation in New York City
Most broken collarbones heal well without surgery, and the value of an evaluation is knowing early which category yours falls into rather than discovering at week eight that the alignment was never going to hold. Dr. Struhl evaluates clavicle fractures at his Manhattan and White Plains offices. Call the New York City office at (212) 207-1990 or the Westchester office at (914) 328-4111 to schedule an appointment.
