A clavicle fracture is one of the most common injuries to the shoulder girdle. Medically, it is also known as a clavicle fracture or a fracture of the clavicle. The clavicle connects the sternum to the shoulder region and is therefore particularly vulnerable in the event of a fall. The fracture is usually caused by a fall onto the shoulder or by breaking a fall with an outstretched arm.
Below you will find more information on diagnosis and treatment, as well as a selection of specialists in clavicle fractures.
Definition: What is a collarbone fracture?
A clavicle fracture is a break in the clavicle. The clavicle forms the bony connection between the trunk and the shoulder girdle. It lies close to the skin and runs between the sternum and the outer shoulder region. As a result, a clavicle fracture is sometimes clearly visible or palpable.
The injury most commonly affects the middle section of the bone. In medical classification, a distinction is also made between fractures in the medial region—that is, toward the center of the body—and in the lateral region, near the acromion.
The lateral third is classified according to Jäger and Breitner, among others. This classification depends on whether the fracture line lies lateral to, between, or medial to the coracoclavicular ligaments. These ligaments connect the clavicle to the scapula and are important for stability.
A clavicle fracture can be simple or unstable. The key factors are whether the fracture ends are displaced relative to one another, whether multiple fragments are present, and whether the skin, nerves, or blood vessels are at risk.
Causes of a Collarbone Fracture
The cause of a clavicle fracture is usually direct impact trauma or a fall onto an outstretched arm. The clavicle can also fracture when an indirect mechanism involving axial compression leads to the fracture.
The clavicle frequently fractures in the middle section (70 percent) or in the medial third. “Medial” refers to the end of the bone closest to the body’s midline. “Lateral,” by contrast, refers to the end farther from the body’s midline.
A common cause is sports and recreational accidents. Contact sports are particularly prone to these injuries, as are any sports involving high-speed falls, such as cycling, skiing, snowboarding, or horseback riding. Traffic accidents can also lead to these injuries.
According to Jäger and Breitner, fractures of the lateral third are classified as follows:
- Type 1: Fractures lateral to the coracoclavicular ligaments (ligaments connecting the clavicle to the scapula)
- Type 2: Fractures between the coracoclavicular ligaments
- Type 3: Fractures medial to the coracoclavicular ligaments
- Type 4: Periosteal avulsion (children)
Risk factors include a hard impact, an unfavorable accident scenario, direct force applied to the shoulder, and falls from a significant height. In children, a broken collarbone may sometimes heal more quickly because the bone still has a high capacity for remodeling. Nevertheless, if a collarbone fracture is suspected, parents should have a doctor check for any accompanying injuries.
Clavicle fractures most often occur on the side closer to the body’s midline (medially) © Liliya | AdobeStock
Symptoms of a Collarbone Fracture
The symptoms of a clavicle fracture usually appear immediately after the accident.
A typical symptom is pain over the collarbone, which worsens with movement. Many people keep the affected arm close to their body and avoid raising it. This significantly limits the arm’s range of motion.
Typically, the medial fragment protrudes upward and may even pierce the skin. A clavicle fracture is also accompanied by pain when moving the shoulder. Bruising, tenderness, and swelling are also present.
Numbness, tingling, or a cold hand are warning signs: blood vessels or nerves may also be affected. Therefore, the doctor should check the patient’s pulse as well as the function of the median, radial, and ulnar nerves.
Diagnosis of a Clavicle Fracture
Diagnosis begins with a physical examination. The treating physician asks about the accident, determines the location of the pain, carefully palpates the clavicle, and assesses the shape of the shoulder. It is also important to check blood flow, sensation, and motor function.
The doctor examines the patient and may order X-rays of the clavicle in two planes (anterior-posterior/axial). This helps determine whether the fracture is simple, comminuted, shortened, or displaced.
In cases of complex injuries, suspected joint involvement, or unclear imaging, a CT scan may also be useful.
Clavicle fractures in combination with scapular fractures (scapula = shoulder blade) in the glenoid neck region lead to what is known as a “floating shoulder.” In this case, surgery is absolutely indicated.
Treatment of a clavicle fracture: conservative or surgical?
The treatment of a clavicle fracture depends on the location, stability, and extent of the injury. The goal is to control pain, maintain or restore bone alignment, and enable good shoulder function.
In milder cases, conservative therapy—that is, without surgery—may be sufficient to treat the clavicle fracture. This includes simple shaft fractures in the medial and middle thirds with fracture ends that are barely displaced.
Immobilization can be achieved with a sling or a backpack-style bandage. After applying the backpack-style bandage and each time it is retightened, the pulse and sensation should be checked. Retightening should be done 1 to 2 times daily during the first week, and once a week during the second and third weeks. After three weeks, the shoulder may be mobilized.
Type I and IV lateral fractures according to Jäger/Breitner are also treated conservatively. The backpack sling does not engage the lateral clavicle. Lateral fractures can therefore only be immobilized with an arm sling.
Non-surgical treatment of a clavicle fracture is primarily an option if the fracture ends are stable, there is no risk to the skin, and there are no nerve or vascular injuries. In such cases, the arm is initially kept at rest. Pain relievers can help alleviate pain. As recovery progresses, physical therapy helps restore shoulder mobility.
Surgical treatment is indicated in cases of
- imminent penetration of the skin,
- shortening of the clavicle by more than 2 cm, and
- a dislocation (displacement) of more than one shaft width, and
- in the case of multifragmentary fractures.
Type II and III lateral clavicle fractures according to Jäger/Breitner also require surgical treatment due to their high instability.
If surgery is performed for a clavicle fracture, plates and screws may be used to stabilize the fracture sites. This is referred to as osteosynthesis. The goal is to stabilize the bone so that it can heal in a controlled manner. This surgical treatment is particularly important when there is significant malalignment or when function is compromised.
All fracture types can be initially immobilized if sensation and a pulse are present in the affected limb.
With conservative treatment, attention must be paid to
- callus formation (possibly with irritation of the brachial plexus) and
- remodeling after one to two years
. As a rule, removal of the osteosynthesis material is necessary after surgical treatment due to the thin layer of soft tissue overlying the clavicle.
Healing Time and Treatment for a Clavicle Fracture
A clavicle fracture heals stably with both conservative and surgical treatment. Bone healing can take up to two years and depends on age, the type of fracture, treatment, and the level of activity.
It usually takes several weeks for the bone to become sufficiently stable; it may take longer before the shoulder can bear a full load again. In children, a clavicle fracture often heals faster than in adults.
Surgical treatment of a clavicle fracture carries a higher risk of pseudarthrosis as a complication (two to nine percent). Scar-related discomfort, irritation, or secondary damage from associated injuries are also possible, but not the norm.
Specialists for a Collarbone Fracture
Orthopedic surgeons and trauma surgeons are responsible for treating clavicle fractures. They assess whether the fracture is stable, whether there are any associated injuries, and whether conservative treatment is possible or if surgical intervention is necessary.
Specialized centers have experience with shoulder injuries, clavicle fractures, and modern osteosynthesis. Precise imaging, a well-reasoned treatment decision, and structured follow-up care are essential.
Frequently Asked Questions
How does a clavicle fracture occur?
A clavicle fracture is usually caused by a fall, particularly onto the shoulder or an outstretched arm. A direct blow, a traffic accident, or a sports injury can also result in a broken clavicle.
How can you recognize a clavicle fracture?
Signs include pain over the clavicle, an abnormal posture of the arm, a palpable step, swelling, bruising, and limited movement. If you experience severe pain, numbness, or visible misalignment, you should seek medical attention promptly.
How is the diagnosis made?
The diagnosis is made through a physical examination and X-rays taken in two planes. The doctor also checks blood flow, sensation, and strength in the arm to rule out nerve or vascular damage.
Does a clavicle fracture always require surgery?
No, many fractures can be treated conservatively. Surgery is more likely to be necessary if the fracture is significantly displaced, shortened, comminuted, or unstable.
How long does healing take?
Healing usually takes several weeks. Depending on the type of fracture and treatment, adults often need 6–12 weeks before the bone can bear weight again. Sports and heavy work should only be resumed after receiving medical clearance.
Can children recover from a collarbone fracture without surgery?
Yes, clavicle fractures in children often heal particularly well because the bone is still capable of remodeling. Nevertheless, the fracture should be monitored by a doctor.
When can you start moving your arm again?
Light movements may be performed depending on the medical findings and following a doctor’s instructions. Putting weight on the arm too soon can interfere with healing. Targeted physical therapy helps build strength and mobility safely later on.
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