BROKEN COLLARBONE

A broken collarbone (clavicle fracture) is a common fracture that many people experience in their lifetime. Some common causes of a fractured collarbone include sports injuries, falling on the shoulder, and trauma from a car accident. The majority of broken collarbones heal with an arm and shoulder sling to keep them immobile while the bone heals. In more severe cases, surgical treatment may be required if the fracture forces parts of the bone out of alignment and therefore, won’t heal naturally.

Anatomy

The collarbone (clavicle) connects the upper part of the breastbone to the shoulder blade. The ribcage, shoulder blade, and collarbone all serve to protect the nerves and blood vessels that lie beneath them. Fortunately for most people with collarbone fractures, these critical structures are rarely injured.

Description

Broken collarbones are a fairly common injury, especially in children and young adults. They account for about 5 percent of all adult fractures. The degree of severity can vary from a minor crack to a full break in many places.

The majority of these types of fractures occur in the middle section of the bone. Occasionally, the bone will break where it attaches at the shoulder blade or ribcage.

What are the symptoms of a Broken Collarbone?

A broken collarbone can cause severe pain and may make it difficult for patients to move their arm or shoulder. Most fractures are caused by a forceful, direct blow to the shoulder. The shoulder may droop downward and forward.

• Inability to lift the arm.
• A grinding sound when attempting to move the affected arm.
• Bruising, swelling or tenderness over the collarbone area.
• Pain that increases with shoulder movement.
• A bulge on or near the shoulder.
• Stiffness or inability to move the shoulder.

Diagnosis

During the initial physical exam, the Orthopaedic physician will ask you how the injury occurred and your symptoms since the injury. The physician will also ask about your medical history. The physician will examine the injured area. With a broken collarbone, there is usually an apparent “bump” over the break fracture site. The bump suggests that a fracture has taken place. The physician will apply light pressure to this area, which may cause pain and discomfort.

In rare cases, a bone fragment may push the skin into a “tent” configuration or even break through the skin. In this case, the physician may order a CT scan to see the fractures in greater detail.
Other tests may be ordered at the time of your exam. This is to make sure that no nerves or blood vessels were damaged when the fracture occurred. The physician may also order x-rays to establish the fracture location and to check for any other shoulder injuries.

Treatment

Your treatment will hinge on the severity of the fracture. Age and other related injuries also factor into whether the physician will recommend surgical or non-surgical options.

Non-surgical treatments

At Orthopaedic Associates of St. Augustine, we believe in first trying all suitable non-surgical methods to increase mobility and function. Generally, broken collarbones can heal on their own without surgery by utilizing methods such as arm support, physical therapy, and medication.

• Arm support: A sling for the arm and shoulder will ensure comfort and lessen pain. The arm and shoulder need to be kept in one position so the injury can heal.
• Medication: The physician may recommend that you take over-the-counter pain medications such as acetaminophen to relieve pain while you heal.
• Physical therapy: Frequently, the physician will recommend that you do exercises to keep proper elbow motion. It is normal to lose some shoulder and arm strength after a fracture, and progressive exercises will help prevent permanent weakness.

You will see your Orthopaedic Associates of St. Augustine physician frequently as the fracture heals. Our staff will take x-rays to make sure the bone is healing correctly. In rare cases, a broken collarbone can shift out of place before it fully heals. You will need to continue to follow up with the physician to make sure that fracture fragments do not shift out of place and the bones heal in the wrong position.

Sometimes a large bump may appear during the healing process. Usually, the bump will decrease in size as it heals, but it may leave a permanent small spot in its place.

Surgical Procedures & Treatments

In cases where the fracture is complex, your Orthopaedic Associates of St. Augustine surgeon may recommend surgical treatment.
Broken collarbone surgery typically involves setting the broken pieces of bone back into their correct positions. This is to ensure that you regain the strength you may have lost from the injury.

The procedure most often used to treat broken collarbones is Open Reduction and Internal Fixation. The bone fragments are placed back into their normal alignment and held in place with specific metal hardware.

Standard methods of internal fixation are:
Plates and Screws: The bone fragments are held in position with surgical screws and metal plates. These are attached to the outer surface of the bone. Post-surgery patients frequently report numb skin below the incision; this usually will decrease over time with the healing. Generally, the plates and screws are not removed after healing unless they cause discomfort to the patient.

Pins or Screws: The fracture can also be held in place with pins or screws after the bone ends have been put in position. The incisions are smaller for the pins or screws are smaller but frequently irritate the patient’s skin, so they are usually removed after healing.

The orthopedic surgeon will recommend using ice and non-prescription medications to help with the pain management after surgery. If the pain is severe, you may be prescribed prescription-strength medicine for a couple of days.

Rehabilitation is crucial to a healthy recovery and return of your shoulder’s motion. Your Orthopaedic Associates of St. Augustine physician will discuss with you whether home therapies will be sufficient or if you should work with a Physical Therapist. In either case, you will need to take exercising slowly and stop if there is any discomfort.

If you are elderly, have diabetes, smoke, or use tobacco products, there are greater risks for complications such as bleeding, infection and difficulty healing. Prior to the procedure, your surgeon will discuss the surgery and any potential complications that you could be at risk.

If you had an accident or fall that has affected your collarbone, call Orthopaedic Associates of St. Augustine at 904-825-0540 to schedule an appointment for an evaluation.