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Clavicle (collarbone) fractures

Your collarbone is an important strut that holds your arm away you’re your midline.  It provides the only bony connection for your shoulder blade to your body.  Clavicle fractures are very common. They usually result from a fall onto the shoulder, a direct blow, or following a fall onto an outstretched arm.  It is normally obvious that you’ve broken your collarbone if there's displacement, but x-rays confirm the pattern and position of the injury. Most fractures occur in the middle section of your collarbone.  

If your bone has broken through your skin then you will definitely need it washing out and fixing, but this is extremely rare.  Occasionally, the bone fragments tent the skin from the inside and cause it to pucker. This can make it necessary to fix the bone to stop the skin breaking down. Occasionally, and normally in high-energy injuries, the collarbone is injured alongside other bones nearby, such as your shoulder blade or ribs.  In this case, the collarbone is normally fixed to improve your recovery and function. 


CT scan of a displaced left broken collarbone after falling from a horse

Do I have to have my collarbone fixed?

Most breaks happen in the middle part of the collarbone and 85% of these will heal on their own. Breaks near either end of your collarbone may be more likely not to heal, so if they are displaced, it is generally best to fix them. Severe separation of the bone ends in middle third breaks slows healing and increases non-union rates, so this can also be considered a reason to fix the bone.

In general, if your broken bone heals, you are likely to do well. However, some patients will have problems even after their broken bone has healed. If your collarbone has healed in a bad position, this can narrow the space beneath your collarbone (thoracic outlet) and cause compression of nerves and blood vessels when your arm is raised.  Shortening and malrotation of the healed collarbone disrupt the strut function of the collarbone and interrupt the motion of your shoulder blade and this can cause both pain and weakness.  

Your decision whether or not to undergo surgery therefore depends on several factors:

  • Your fracture pattern – (how many pieces are there? How displaced are the fragments? Where in the bone is the fracture - medial/midshaft/lateral?)
  • Your gender - (females have slightly higher rates of nonunion than males)
  • Your functional demands (are you an athlete, a manual worker or do you work at a desk?)
  • Your philosophy (would you rather have it fixed or wait and see how you go?)

Collarbone fixation is recommended in appropriate cases to improve your chance of bony healing and your functional outcome.  If you choose not to have surgery and your collarbone doesn’t heal, delayed fixation has generally good results, although it carries a slightly higher risk of complications.