Collarbone Fractures (Clavicle Fractures): Overview

Collarbone Fractures (Clavicle Fractures): Overview

The clavicle, or collarbone, is a thin bone in the front of the body that sits between the shoulder and breastbone. The clavicle connects the breastbone or sternum to the front of the shoulder blade or scapula. The main function of the clavicle is to provide support to the shoulder.

The clavicle is the most frequently broken bone in the body, making up 5-10% of all emergency room visits for broken bones. Young, active patients have the highest rate of clavicle fractures. However, they can occur in people of all ages. Most commonly, a clavicle fracture is caused by a direct hit to the bone or a hit to the outside of the shoulder. Another common cause is a fall on an outstretched hand, as shown here.

A broken collarbone can consist of one fracture or several fractures. They can be non-displaced, where the normal bone position does not change, or they can be displaced, where the normal bony position and alignment does change. Clavicle fractures can occur in a variety of locations on the clavicle: the middle portion, also referred to as the midshaft, the outer portion near the shoulder, also referred to as the distal end, or the inner portion near the breastbone, called the medial end.

Most clavicle fractures occur in the midshaft, followed by the distal end then the medial end. The midshaft is the area most at risk for fracture, as there are no stabilizing ligaments in this portion of the clavicle. While there are several ligaments that support the ends of the clavicle, one set of ligaments is at particular risk of tearing in the setting of a distal clavicle fracture: the coracoclavicular ligaments or "CC" ligaments. These ligaments assist in stabilizing the end of the clavicle to the shoulder blade.

In addition to these ligaments, many important blood vessels and nerves pass near the clavicle and can also be at risk for injury following a clavicle fracture. After a clavicle fracture, the patient may have pain, bruising, and difficulty moving the shoulder. If the injury has resulted in displacement of the bone, the patient may have a noticeable bump near the injury.

After an injury, a healthcare provider will ask a patient how the injury occurred, examine the shoulder, and check for pulses, sensation, and movement in the arm and hand. The skin surrounding the fracture is checked to ensure the bone did not break through the skin. They will also check if the skin has pressure from an underlying displaced bone, which is known as skin tenting.

The diagnosis of a clavicle fracture will be confirmed using x-rays. The healthcare provider will order multiple views of the clavicle and shoulder to determine the location and severity of injury. A CT scan may also be ordered to further assess the bone and vessels, and assist in surgical planning, if needed. The health care provider will then review all findings and determine what treatment will be best for the patient.