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Broken Collarbone (Clavicle Fracture)

Lea este articulo en EspanolHard falls and collisions are a reality of sports, and they often lead to injuries. Taking a spill and falling on a shoulder or with arms outstretched puts tremendous stress on the shoulder and on a small bone called the clavicle, or collarbone. If the stress is too great, the collarbone can break.

Broken collarbones are one of the most common sports injuries among kids and teens.

About Broken Collarbones

The collarbone runs between the top of the breastbone (sternum) and the shoulder blade (scapula) and helps connect the arm to the rest of the body. You can feel your collarbone by touching the area between your neck and your shoulder. Most people can see their collarbones sticking out beneath the skin when they look in the mirror.

A broken collarbone typically occurs as a result of a direct blow to the shoulder or a fall onto an outstretched arm. Collarbone breaks (fractures) are common in contact sports (like football, lacrosse, and hockey) and in sports where there is a chance of a hard fall (such as biking, skiing, snowboarding, and skateboarding). They also can occur from direct trauma to the collarbone during a car collision or other accident.

clavical_fracture_illustration

Most collarbone fractures will heal on their own if the arm is properly immobilized in a sling and the injury is treated with ice and physical therapy. Sometimes, however, if the collarbone is significantly displaced or the break is particularly severe, surgery may be needed to realign the bone, with screws and plates inserted to hold the collarbone in place as it heals.

Symptoms

If your child has a broken collarbone, the most obvious symptoms will be pain in the affected area and difficulty moving the affected arm. Other symptoms include:

Diagnosis

To diagnose a collarbone fracture, a doctor will ask how the injury occurred and what symptoms your child has. The doctor will examine your child's shoulder and may press gently on the collarbone to see if it is tender, determine where the fracture is, and make sure no nerves or blood vessels are damaged. The doctor might check the feeling and strength in your child's arm, hand, and fingers to see if there is nerve damage.

If a broken collarbone seems likely, the doctor will order X-rays of the shoulder and the affected area to pinpoint the location of the break and evaluate its severity. X-rays also show if any other bones are broken. In some cases, if other bones are broken or if the doctor needs to see the fracture in greater detail, a computerized tomography (CT) scan will be performed.

Causes

Most collarbone fractures are due to a fall onto the shoulder, but they can also follow a fall onto an outstretched hand or a direct blow to the collarbone itself (as from a sports-related injury or car accident). Newborns also can incur a broken collarbone as they pass through the birth canal.

In a collarbone fracture, the break can happen in three areas of the collarbone:

  1. Most occur in the middle third of the bone, generally from a hard fall or direct impact to the middle of the collarbone.
  2. A fall or impact that transmits force to the outside or top of the shoulder can cause a fracture on the outer third of the collarbone, the part closest to the shoulder itself.
  3. The rarest type of collarbone fracture occurs on the inner third of the collarbone. These are almost always the result of a direct blow to the front of the chest, such as from an impact with a steering wheel during a car collision.

Risk factors that can increase the chances of a collarbone fracture include:

Prevention

Because they happen suddenly and unexpectedly, collarbone fractures can be hard to prevent, but a few precautions can help kids decrease their risk:

Treatment

Treatment for a collarbone fracture depends upon the type of fracture and how severe it is. Most fractures can be treated with simple comfort measures until they heal.

But fractures where bone fragments on each side of the break are misaligned or where the bone is broken into several pieces (comminuted fractures) may require surgery to ensure proper healing. Compound fractures, where the broken bone pierces the skin, require immediate, aggressive treatment to reduce the risk of an infection.

For fractures where the bone fragments stay aligned, these treatments are recommended:

The special screws and metal plates used when a significantly displaced, compound, or comminuted fracture requires surgery won't need to be removed once the bone has healed unless they cause irritation.

After surgery, doctors will often prescribe a therapy regimen to help restore movement and strengthen the shoulder. Typically, therapy will start with gentle motion exercises, and strengthening exercises will be added as the bone heals.

For younger children, healing time can be as fast as 3-4 weeks. For teens, healing time is usually about 6-8 weeks. During this time, your child should take it easy to reduce the risk of reinjuring the bone. After that, follow up with the doctor about when your child can resume normal activities.

Reviewed by: Alfred Atanda Jr., MD
Date reviewed: September 2011

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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