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Collarbone Fracture

Alternate Names

  • clavicle fracture
  • broken collarbone

Definition

A collarbone fracture is a break that occurs in the collarbone, also called the clavicle. The collarbone is the bone that connects the breastbone, also called the sternum, to the scapula (shoulder blade).

What is going on in the body?

The collarbone is a long, narrow, S-shaped, solid bone. Because of its location and shape, it can be injured when the arm, elbow, or shoulder suffers any trauma. The collarbone is located in front of a number of key nerves and blood vessels. Rarely, these nerves and blood vessels may be injured when the collarbone is broken.

Risks

What are the causes and risks of the condition?

A collarbone fracture is often caused by a fall. Trauma may also occur during contact sports, such as ice hockey, football, or wrestling. Other causes may include:
  • a tumor in the collarbone
  • conditions that cause weak bones, such as osteoporosis
  • physical abuse, including child abuse or elder abuse

A newborn's collarbone may be broken, either unintentionally, or on purpose by the healthcare professional in an extreme emergency, during birth as the child travels through through the birth canal.

Prevention

What can be done to prevent the condition?

A person can prevent some injuries by following sports safety guidelines for children, adolescents, and adults. A healthy diet with adequate calcium can help prevent some fractures caused by bone weakness.

Diagnosed

How is the condition diagnosed?

After doing a complete medical history and physical exam, the doctor may order:
  • a biopsy of any fluid or growths to check for infection or tumors
  • a nerve conduction test, also called an NCV, to measure nerve damage from the injury
  • blood tests to rule out infection, including a complete blood count
  • imaging tests, such as MRI, if a tumor is suspected
  • X-rays to locate the break and its severity

Long Term Effects

What are the long-term effects of the condition?

Long-term effects will depend on the extent of the fracture and the success of treatment. If a person was involved in sports or heavy lifting before the injury, his or her normal range of motion in the shoulder may be decreased. About 30% of the patients find that the arm and shoulder are weaker and tire more easily over the long term. Chronic pain or soreness in the shoulder and collarbone may also occur. Damage to the nerves and blood vessels is also possible, leading to decreased sensation and other tissue damage.

Other Risks

What are the risks to others?

A collarbone fracture poses no risk to others.

Treatments

What are the treatments for the condition?

Minor to moderate injury may require "RICE" therapy:
  • R = rest or reduced activity
  • I = ice or cold packs applied to the shoulder, for 15 minutes every 2 hours
  • C = compression of the affected area, such as with a special splint called a figure-of-8 splint or a sling
  • E = elevation of the shoulder or affected arm
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (i.e., Advil, Motrin) or naproxen (i.e., Anaprox, Aleve, Naprosyn), may be recommended to reduce inflammation and discomfort. After a few days to weeks, the initial pain and swelling will begin to subside, and the bone will start to heal. At this time, physical therapy or strength training exercises may help to increase the strength of the tendons and muscles. Ultrasound may also be used to warm the muscles and improve blood flow.
If conservative treatment is not successful, surgery may be needed. Sometimes, a bone graft may be needed to promote healing.

Side Effects

What are the side effects of the treatments?

There may be stomach upset, ulcers, or an allergic reaction to NSAIDs. Splints or slings can cause muscle tightening as well as skin irritation. Treatments that require surgery pose a risk of bleeding, infection, and reactions to anesthesia. Generally the indications for surgery include an open fracture, where the bone protrudes through the skin; a nerve or vessel injury; and widely displaced fractures that tent the skin.

After Treatment

What happens after treatment for the condition?

In some situations, no further treatment is needed. Physical therapy and daily exercises may be advised to strengthen the muscles and help the bone continue to heal. Complete recovery from the fracture may take several months.

Monitor

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare professional.

Sources

[hyperLink url="http://www.med.jhu.edu/ortho/sports/clavicle.htm/" linkTitle="www.med.jhu.edu/ortho/sports/clavicle.htm/"]www.med.jhu.edu/ortho/sports/clavicle.htm/[/hyperLink]

[hyperLink url="http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=173&topcategory=Shoulder/" linkTitle="orthoinfo.aaos.org/"]orthoinfo.aaos.org/[/hyperLink]

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

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