Clavicle Fracture (Broken Collarbone)

How collarbone fractures happen

The clavicle acts as a strut that holds the shoulder away from the chest. A fall onto the side of the shoulder transmits force along the bone, which most often breaks in its thin middle third. Common causes:

• falling onto the shoulder while cycling, skiing, playing football or rugby
• falls in older adults
• car and motorcycle crashes
• birth injury in larger babies during difficult deliveries

Types

Fractures are also described as undisplaced (bone ends aligned) or displaced (bone ends moved apart or overlapping), and simple or comminuted (several pieces).

Symptoms

• sudden pain over the collarbone
• swelling and bruising
• a bump, step or sag where the bone is broken
• pain when moving the arm, often holding the arm against the body
• a grinding feeling when moving the shoulder
• the shoulder may sit lower and further forward

Diagnosis

A doctor will check the skin over the fracture, feel along the bone, check pulses, sensation and strength in the arm, and listen to the lungs. X-rays confirm the fracture and show displacement. CT is used for complex or inner-third fractures.

Treatment

Non-surgical (most fractures)

• Sling for comfort, usually for 2 to 6 weeks. Figure-of-eight braces are no longer preferred as they are less comfortable and offer no advantage.
• Pain relief: ice for 15 to 20 minutes at a time, acetaminophen (paracetamol) or ibuprofen; follow the label dose.
• Early gentle movement: pendulum exercises and elbow, wrist and hand movements in the first weeks to prevent stiffness.
• Physical therapy to restore shoulder movement and strength once the bone begins to heal.
• Follow-up X-rays to confirm healing.

A firm bump (callus) forms as the bone heals and usually becomes smaller over a year.

Surgery

Surgery with a plate and screws or an intramedullary rod may be recommended for:

• open fractures or skin at risk of breaking
• nerve or blood vessel injury
• shortening or displacement of more than about 2 cm, especially in active adults or athletes
• several broken bones in the same arm or a "floating shoulder"
• displaced outer-third fractures with ligament injury
• fractures that fail to heal (nonunion)

Surgery lowers the risk of nonunion and may allow a faster return to function, but carries risks of infection, nerve numbness below the scar and hardware irritation that sometimes needs removal.

Recovery and healing time

• Avoid lifting anything heavier than a cup of coffee with the injured arm for the first several weeks.
• Most people return to desk work within days to a couple of weeks.
• Contact sports and heavy lifting are usually avoided until the bone has fully healed and strength has returned, often 3 months or more.
• Driving should wait until you can control the wheel safely without a sling.

Complications

• Nonunion: the bone fails to join, more likely in displaced fractures, smokers and older adults.
• Malunion: healing with shortening or angulation, which can cause a bump, shoulder fatigue or weakness.
• Nerve or blood vessel injury: rare.
• Collapsed lung: rare, from inner or high-energy fractures.
• Shoulder stiffness.

Collarbone fractures in babies

A newborn may have a broken collarbone after delivery. Signs include not moving one arm, crying when the arm is moved, and a lump that appears as it heals. These heal quickly, usually with gentle handling only, but a doctor should rule out a nerve injury of the arm.

Frequently asked questions

How long does a broken collarbone take to heal?

In adults, a broken collarbone usually takes 6 to 12 weeks to heal, with full strength returning over about 3 months. Children heal faster, often in 3 to 6 weeks, and newborns in 2 to 3 weeks. Smoking and displacement can slow healing.

Does a broken collarbone need surgery?

Most do not. Middle-third fractures usually heal well in a sling. Surgery is considered for open fractures, injuries to nerves or vessels, severely displaced or shortened fractures in active adults, some outer-end fractures, and breaks that fail to heal.

What does a broken collarbone feel like?

It causes sudden, sharp pain over the collarbone, swelling and bruising, and often a bump or sag. Lifting or moving the arm is painful, and people tend to hold the arm against their body. A grinding feeling may be felt with movement.

Can you move your arm with a broken collarbone?

Moving the arm is painful but possible, and gentle movements of the elbow, wrist and fingers are encouraged early to prevent stiffness. Avoid lifting the arm above shoulder height and carrying weight until your doctor or physical therapist advises.

How should I sleep with a broken collarbone?

Many people find it most comfortable to sleep propped up in a recliner or with several pillows, at least for the first couple of weeks. Avoid lying on the injured side. Keep the sling on at night if it helps with pain.