The clavicle, commonly known as the collarbone, is a long, slender bone located between the rib cage and the shoulder blade. It can be fractured in one or multiple places due to various injuries such as a simple fall or a traffic accident.
Most clavicle fractures occur in the middle portion of the bone. However, the fracture can also occur near the joint connecting it to the rib cage (proximal fractures), or near its attachment to the shoulder blade (distal fractures). In some cases, the fracture may extend into the joint, known as an intra-articular fracture.
In certain cases, clavicle fractures do not require surgery—especially if there is no displacement, or if the shortening of the bone is within acceptable limits. These non-operative clavicle fractures are treated by immobilizing the area with a figure-of-eight bandage and/or an arm sling. Most clavicle fractures heal within approximately 4 to 5 weeks.
What Is the Clavicle?
The clavicle, commonly referred to as the collarbone, is a long and thin bone located at the front of the shoulder girdle. It extends between the sternum (breastbone) and the scapula (shoulder blade), forming two joints: the acromioclavicular joint and the sternoclavicular joint. The clavicle serves as a connection between the arm and the torso.
Main functions of the clavicle include:
- Support: It helps connect the arm to the body and supports its movement.
- Protection: It protects critical structures underneath, such as nerves and blood vessels.
- Facilitating Movement: It allows the shoulder joint to achieve a wide range of motion.
What Are the Symptoms of a Clavicle Fracture?
- Pain: Pain occurs over the fractured clavicle when moving the arm or even the body.
- Swelling, tenderness, bruising
- Skin tension: In cases of significantly displaced fractures, the bone fragments may be visible or palpable under the skin.
- Grinding or clicking sound: Bone fragments may rub against each other during movement, causing audible noise.
- Loss of motion: Pain may lead to difficulty in moving the shoulder.
How Is a Clavicle Fracture Diagnosed?
Patients with a clavicle fracture typically present to the emergency department. On physical examination, tenderness and visible deformity over the clavicle are often noted. Diagnosis is confirmed by X-rays focusing on the clavicle. In intra-articular fractures involving the shoulder or sternoclavicular joint, CT or MRI scans may be required.
How Is a Clavicle Fracture Treated?
Like all bone fractures, a clavicle fracture must be immobilized to allow healing. If surgery is not needed, the fracture can be stabilized using a figure-of-eight bandage and/or an arm sling as effectively as possible.
Treatment of Clavicle Fractures in Children
Clavicle fractures are among the most common fractures in childhood. In most cases, treatment involves using a simple arm sling or figure-of-eight bandage for about two weeks. The first week is usually painful, and due to discomfort, children may avoid moving the arm, which is temporary. During this period, sleeping in a sitting position can be more comfortable. Pain relievers can be given under medical supervision. After the first week, the sling may be removed periodically.
It is also normal for a lump or swelling to remain at the fracture site in children, and this may persist for up to a year.
Once the child feels comfortable, they may return to non-contact sports such as swimming. However, we do not allow return to contact sports like football or basketball before six weeks.
When Is Surgery Required for a Clavicle Fracture?
Surgery is necessary in the following situations:
- Open fractures: When bone fragments break through the skin.
- Severely displaced fractures: That cause noticeable skin tension or threaten circulation and wound healing.
- Associated vascular or nerve injuries
- Floating shoulder injury: A combined fracture of the clavicle and scapular neck requires surgical fixation of both.
- Fractures with displacement greater than 15–20 mm
- Bilateral clavicle fractures: (Both right and left clavicles) if displaced
- Multiple fractures elsewhere in the body at the same time
- Patients with epilepsy
- Head trauma accompanying the fracture
- Displaced distal or proximal intra-articular fractures
In addition, clavicle fractures in elite or professional athletes who aim to return to sport quickly are typically treated with surgery.
Risks of Clavicle Fracture Surgery
Like all surgeries, clavicle fracture surgery carries certain risks, which are carefully assessed beforehand. The most common complication is infection, which is minimized using sterile techniques.
Bleeding during or after surgery is another potential risk, particularly in patients using blood thinners. Nerve or vascular injuries are rare but serious complications. Fortunately, these are extremely rare when surgery is performed by an experienced orthopedic surgeon.
Clavicle Fracture Surgery
In open surgery, the fractured bone fragments are realigned and stabilized with an anatomically contoured plate and screws specifically designed for the clavicle. This technique is called Open Reduction and Internal Fixation (ORIF).
The type of plate used depends on the location of the fracture:
- Midshaft Clavicle Fractures:
This is the most common type of clavicle fracture. Surgery typically involves the use of specially designed plates for the middle portion of the clavicle. - Medial Clavicle Fractures:
Also known as fractures of the inner part of the clavicle. These are the least common type. The fracture occurs near the sternoclavicular joint, where the clavicle meets the breastbone. These are often intra-articular fractures and may occasionally present as fracture-dislocations. - Distal Clavicle Fractures:
These occur near the acromioclavicular (AC) joint, where the clavicle connects to the acromion. The most common surgical approach for these fractures involves the use of a hook plate, which is typically removed 6 to 9 months after the fracture has healed.
To watch a distal clavicle fracture surgery performed by Dr. Utku Erdem Özer, click here.
How Long Does Clavicle Fracture Surgery Take?
The surgery typically takes between 45 minutes to 1 hour.
How Long Does It Take for a Clavicle Fracture to Heal?
Bone healing usually takes 3 to 6 weeks in children, and 6 to 12 weeks in adults.
Clavicle Fracture Recovery Process
After surgery, a one-day hospital stay is usually sufficient. Applying cold therapy (ice) to the surgical area significantly reduces the need for pain medication. The surgical wound typically heals within 10 to 15 days. If waterproof dressings are used, you may shower during this period.
Using a simple arm sling for the first 10 days after surgery helps control pain. The sling can be removed periodically during the day to allow elbow, wrist, and hand movements. A diet rich in vitamin D, calcium, and protein supports faster bone healing.
Clavicle Fracture Healing in Children
In children, healing generally takes 3 to 6 weeks, compared to 6 to 12 weeks in adults. Limited arm movement, consistent use of the sling, and participation in physical therapy after healing are crucial. A swelling over the fracture site is common in children and may persist for up to a year.
Once the child feels comfortable, they can return to non-contact sports such as swimming. However, contact sports like football and basketball should be avoided for at least 6 weeks.
For more information on osteolysis and shoulder pain caused by distal clavicle issues, see our article on osteolysis.
Signs of Clavicle Fracture Healing
Clavicle healing may take several weeks to months. Key signs of healing include:
- Decreasing pain and swelling
- Gradual return of shoulder and arm mobility
- New bone formation at the fracture site
- Regular follow-up with your physician
Factors Affecting the Healing Process
- Fracture Location and Severity:
More severe or displaced fractures tend to take longer to heal than non-displaced ones. - Treatment Method:
Non-surgical methods (sling and rest) often result in slower healing than surgical treatment. However, post-operative rehabilitation is also essential for recovery. - Overall Health:
General health conditions like smoking, poor nutrition, diabetes, or other chronic illnesses may delay healing. - Rehabilitation:
Adherence to a physical therapy program helps regain range of motion and muscle strength, speeding up the overall recovery.
Tips for a Smooth Recovery
- Sling Use:
Regular use of the sling as recommended helps ensure proper bone alignment and healing. - Rest and Protection:
Resting and protecting the injured area is crucial. Avoid excessive motion and heavy lifting. - Nutrition:
A diet rich in calcium and vitamin D supports bone regeneration and overall healing.
Postoperative Pain After Clavicle Surgery
Pain after surgery is a normal part of the recovery process. It is typically more intense in the first few days and is manageable with painkillers. Over time, pain diminishes and mobility improves.
| Pain Phase | Management Methods |
| First Few Days | Painkillers, rest |
| Following Days | Physical therapy, exercise |
| Unusual Symptoms | Contact your doctor |
Sleeping Position After a Clavicle Fracture
During the first week after the fracture, the optimal sleeping position is semi-upright, similar to a reclined beach chair. Support the back of the shoulder and elbow with pillows to minimize pain.
Return to Activities After Clavicle Surgery
For cyclists, indoor trainer workouts can typically resume as early as post-op day 3 or 4. Outdoor cycling or running is usually allowed after the 6-week control X-ray, depending on healing progress.
Return to sports that involve frequent overhead arm use (e.g., volleyball, basketball, swimming) generally takes 8 to 12 weeks.
Should the Metal Plate Be Removed After Clavicle Surgery?
Plates and screws are generally removed no earlier than 9 months after surgery—but in most cases, removal is not necessary. Since the clavicle is close to the skin surface, implants may be visible or cause discomfort, especially in thin patients. In such cases, implant removal is recommended when appropriate.
In some distal clavicle fractures, a hook plate is used, which must be removed around the 9th month post-surgery. This is because the hook extends into the subacromial space, which may cause pain during overhead shoulder movements.
To watch a plate and screw removal surgery performed by Dr. Utku Erdem Özer, click here.
Thank you for reading this article. For more information, feel free to visit the homepage at utkuerdemozer.com.
