The clavicle is the bone situated in the front of your the chest. It is the only bone connecting the torso to the arm. There is a joint at each end of the clavicle. The sternoclavicular (SC) joint (near the center of the body) and the acromioclavicular (AC) joint (near the shoulder).
Clavicle fractures can occur in both the old and the young. Thought to be more common in the younger age ranges, it is becoming very common among the active older populations. Generally, these fractures are caused by high-energy traumatic activities such as skiing, snowboarding, and mountain biking. Clavicle fracture make up 4% of adult fractures.
Fractures of the clavicle occur from a fall on an outstretched arm or a direct blow to the shoulder region. Clavicle fractures are generally described by breaking up the clavicle into thirds (distal, midshaft, and medial). 75% of all fractures are in the midshaft.
These fractures are diagnosed by x-ray in the urgent care, emergency department, or physician’s office. These fractures whether treated with surgery or without (nonoperative) are followed closely by an orthopedic surgeon with regular x-rays.
- Nonoperative – this treatment is generally reserved for clavicles that have some kind of boney contact on imaging. Treatment includes a sling for 2-4 weeks and strengthening starting at 6 weeks. More displaced clavicles can be treated without surgery and have a high rate of healing (85-90%), but there is a risk with more displaced fractures that the bone either won’t heal (nonunion) or will heal in an awkward position (malunion) with symptoms.
- Operative – Fractures of the clavicle with 100% displacement (no boney contact) and/or comminution (>2 fragments of bone) can be treated well with surgery. This outpatient (same-day) surgery for these fractures can decrease the chance of a nonunion or symptomatic malunion from 10-15% to 1%. This decision to have surgery or not should be made with your treating surgeon to find out if it is the best option in your specific situation.
- Preferred surgical method: Clavicles are most commonly fixed with a plate and multiple screws. This holds the fracture reduced and stabilizes the bone so that the body can heal it appropriately
- Plate removal: Historical data suggests that 15% of patients choose to get the plate and screws removed because of discomfort or dislike of appeareance, but in my practice it is closer to 5%.