Have you broken your collarbone? Are you eager to learn what the treatment will be like and the recovery period? You are in the right place!
In this article, I summarise the key findings from international scientific literature on clavicle fractures treatment and recovery time.
I am addressing the most frequently asked questions from online users about collar bone fractures. I also base on my experience as a diagnostic radiographer.
The aim is to reassure you about the progression of this fracture!
Happy reading!😀
(Any questions? Remarks? Let’s meet in the comment questions?🙏
Last update: March 2024.written by Juliet Semakula, diagnostic radiographer.
Disclaimer: no affiliate links:
Before delving into your questions let us briefly review some anatomy? Promise you only a tiny bit!
A bit of anatomy!
The collar bone is a thin bone that connects your sternum (chest bone) to the tip of your scapula (shoulder blade).As projected in the image below
The clavicle is quite a fragile bone, and it is unusual to sustain any injury without trauma. This may be caused by a fall onto an outstretched hand, impact directly onto the shoulder or to the collarbone itself.
A clavicle and shoulder blade are held together by ligaments which can also be damaged in the process.
▶️Types of clavicle (collarbone) fractures.
1️⃣Grade I fractures occur lateral and there is usually a slight displacement of the joint and a badly stretched or partially torn acromioclavicular ligament.
2️⃣Grade II fracture occur medially and there is usually a partial dislocation of the AC joint with a complete tear of the acromioclavicular ligament and a partial disruption of coracoclavicular ligament.
3️⃣Grade III is a complete disruption of the acromioclavicular and coracoclavicular ligaments. It is still rare for a grade III sprain to require surgery as most will heal themselves.
4️⃣Grade IV to VI injuries are complications of a standard Grade III disruption due to the displacement of the collarbone and usually require surgery.
Grades I, II and III very rarely require surgery and heal by themselves, through guided physiotherapy.
Types II and VI are classified as unstable fractures, and patients suffering from these fractures complain of pain and functional limitations if treated only conservatively, leading to controversy about how they can be best managed or treated.
▶️How do you know you might have had a clavicle fracture?
🟠Usually, you will feel pain that is well localised and exacerbated by movement of the arm.
🟠 You may notice localised swelling and tenderness over the affected area.
🟠At the time of injury, you may feel a cracking sensation around the fractured site.
🟠 Because the clavicle lies close to the skin, there could be a visible bulge due to hematoma (bone angulation or displaced bone edges.
Sometimes a broken collarbone can also lead to other complications that cause other symptoms such as:
➡️Chest pain
➡️ Difficulty breathing
➡️Coughing blood
You can only confirm this only when you see your doctor for a full examination and x-rays taken.
▶️Treatment options of clavicle (collar bone) fracture:
The treatment of your fracture will depend on the location, displacement and involvement of ligaments.
X-rays will be taken to determine the extent of your brake.
Image of collar bone fracture:
➡️Conservative treatment:
If your fracture is not displaced or minimally displaced it will be treated conservatively by this, I mean:
1️⃣You will be given an arm sling to help with immobilisation. Usually, you will wear it for two weeks or more depending on how your fracture heals.
As soon as the initial pain improves shoulder motion is advisable to avoid stiffness of the joints.
➡️Possible complications.
🟢 Asymptomatic non-union
🟢Development of AC joint arthritis
Distal clavicle fractures may be treated conservatively or surgically, and there is no gold standard.
Conservative treatment of distal clavicle fractures may result in non-union when this happens, usually surgical treatment may be recommended.
▶️Surgical treatment option:
If your doctor tells you that your fracture will need surgery, here is what might happen. You will be told what kind of surgery based on your fracture.
There are different types of surgery fixation options that can be used to fix your fracture for example:
⚡Pre-contoured locking plate.
⚡Hook plate.
⚡Coracoclavicular (CC) fixation with a screw.
⚡Flexible material or arthroscopic technique,
⚡Tension band wiring
⚡Trans-acromial fixation.
Any plate or method the doctor decides to use will help align the fracture site and will give it better stability. The aim is to see that you completely recover from your injury.
However, searching through scientific publications I have not seen any data on which fixation method is the gold standard. Furthermore, there are no prospective randomised studies enabling a comparison of these different treatments.
You should be rest assured that your doctor should be skilled with various fixation methods to decide which is more suitable for you.
Pre-contoured locking plate.
Recovery of this type of treatment is sought to be better in the first 6 weeks of open reduction and internal fixation.
Possible complications (delayed surgery and post-surgery) from studies
Postoperative chest x-rays are required after clavicle fracture repair to rule out pneumothorax (PTX).
A review of postoperative radiographs for all 631 patients revealed none (0%) with a postoperative iatrogenic pneumothorax.
Randomised controlled trial from the Canadian Orthopaedic Trauma Society, stated that surgical fixation of displaced midshaft clavicle fractures resulted in superior functional outcomes, lower risk of non-union, and patient satisfaction with perceived appearance of the shoulder compared with those managed non-surgically. (2007).
Other studies have found that delayed surgery may result in comparable functional outcomes to immediate surgical results to early surgery, suggesting that surgical management may be appropriately reserved only for those patients who eventually go on to non-union with trials of nonsurgical management. (Woltz, 2017).
▶️Recovery for a clavicle fracture
I have seen so many questions about the recovery time of a broken fracture. I will answer them based on scientific publications and as an experienced radiographer.
⏩Your questions
1️⃣ What is the fastest way to heal a collarbone fracture.
I cannot promise you that there is a quick way to heal your fracture, but most clavicle fractures heal without any problem after treatment.
In general, both conservative or surgery treatment, recovery is similar, usually returning to normal activity around three months or so and full recovery up to 6 to 12 months after surgery.
However, it may take several months for your symptoms to settle completely. Sometimes you might feel pain or discomfort, stiffness, decreased strength and swelling.
And if you suffer from diabetes, it might take longer for your bones to heal.
You can also help speed up your healing by:
🚬 If you’re a smoker you should minimise it because smoking has been associated with hindering bone union/healing.
🤸Try to take it easy and minimise movements that will disturb fracture healing, things like sports or exercises which could impact on your fracture.
🩺 Follow your doctors’ instructions and do not stress yourself, your body has a natural way of helping your bone to heal.
🥗 A balanced diet rich in vitamins and calcium will help with your bone healing.
2️⃣ What is the timeline of wearing a sling?
✅ You will be given a sling to support your arm, this should be used for 2 to 6 weeks whilst the injury heals.
✅ You can wear the sling during the day but remove it for exercises and personal hygiene.
✅You can wear it at night time if you find it more comfortable, but you don’t have to.
This will be up to you to experiment, as some people find wearing a sling while sleeping more comfortable.
⚠️Caution⚠️! The length of time the sling will be required is based on the severity of the injury. Varying from three to six weeks for children and six to 12 weeks for adults.
As your pain improves, you will be able to move your arm more comfortably. (NHS guidelines)
Usually at this point you are given an appointment to return to the fracture clinical for follow up if needed.
3️⃣What to do and not to do with a broken collar bone at home.
🛌You may find it easier to sleep propped up with pillows, to be more upright.
🧊Use ice over the injured area to help with pain and swelling. An ice pack or a bag of frozen peas wrapped in a tea towel can be used for 10 minutes at a time.
🏋️ Avoid lifting and overhead movement for 6 weeks.
🚘You should not drive whilst in a sling.
🧑💼 You can return to work as soon as you are able to do your normal duties.
4️⃣Returning to sports after plate fixation.
Plate fixation of displaced clavicle fractures is a safe procedure resulting in excellent functional outcomes, with an early return to the same level of sports in most patients.
Returning to sports should be based on an individual basis, It will depend on how you feel in your recovery.
A total of 54 athletes with displaced midshaft clavicle fractures were treated with plate fixation between November 1, 2008, and December 31, 2012. The mean follow-up time was 22.4 months.
Of the 54 patients, 53 returned to sports after open reduction and internal fixation of their fracture; 94% returned to the same level. The mean time to return-to-sport was 68 days (range, 5-180 days).
Nine (16.6%) of the cases returned to sports before 6 weeks after surgery, 40 (74%) returned between 6 and 12 weeks, (Ranalletta, 2014)
Based on scientific publications, Plate fixation of displaced clavicle fractures is a safe procedure resulting in excellent functional outcomes, with an early return to the same level of sports in most patients.
🧘Simple home exercise to help with your healing. You can start them straight away unless advised by your doctor not to.
Place unaffected arm on a solid surface to help with your balance, fractured arm hang down towards the ground. Repeat in both directions.⤵️
Practice straightening and bending your elbow and wrist to prevent it from becoming stiff. ⤵️
Practice bringing your shoulder blades back. Turn your head to one side until you feel a stretch. Hold for 5-10 seconds. Repeat to the other side until you feel the stretch on the opposite side. Hold for 5-10 seconds. and down and also tilt your head towards your shoulder.⤵️
What you should know!
10 to 30 % 0f clavicle fractures are treated by conservative management. It is widely accepted but if your fracture is unstable it will usually require surgical treatment to obtain superior clinical outcome.
This what i wanted to tell you about clavicle fracture, I wish you a quick recovery !🙋
There are a lot of publications about clavicle fractures, below are some of the resources I have relied on for this article.
📚Sources:
Eiff, MP, Hatch, et al. Clavicle and scapula fractures. In: Fracture Management for Primary Care, 2nd ed, WB Saunders, Philadelphia 2002. p.198
Canadian Orthopaedic Trauma Society: Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomised clinical trial. J Bone Joint Surg Am. 2007;89:1-10.
Woltz S, Stegeman SA, Krijnen P, et al.: Plate fixation compared with nonoperative treatment for displaced midshaft clavicular fractures: A multicenter randomised controlled trial. J Bone Joint Surg Am 2017;99:106-112.
Ganta, A. , Solasz, S. , Fisher, N. , Leucht, P. , Konda, S. & Egol, K. (9900). Pneumothorax After Superior Plating of Clavicle Fractures: Are the Concerns Warranted?. Journal of the American Academy of Orthopaedic Surgeons, Publish Ahead of Print , doi: 10.5435/JAAOS-D-23-00634.
NEER CS 2nd. Fracture of the distal clavicle with detachment of the coracoclavicular ligaments in adults. J Trauma. 1963;3:99-110.
Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43-50.
Kim DW, Kim DH, Kim BS, Cho CH. Current Concepts for Classification and Treatment of Distal Clavicle Fractures. Clin Orthop Surg. 2020 Jun;12(2):135-144. doi: 10.4055/cios20010. Epub 2020 May 14. PMID: 32489533; PMCID: PMC7237254.
Ranalletta M, Rossi LA, Piuzzi NS, Bertona A, Bongiovanni SL, Maignon G. Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes. Am J Sports Med. 2015 Mar;43(3):565-9. doi: 10.1177/0363546514559913. Epub 2014 Dec 9. PMID: 25492034.