A clavicle fracture, commonly called a broken collarbone, usually occurs after a fall, sports injury, bicycle crash, or direct impact to the shoulder. Most isolated clavicle fractures can be treated without surgery. However, fracture location, displacement, comminution, skin condition, associated injuries, patient age, and activity demands can all influence the treatment plan.
This evidence-based overview explains the symptoms, diagnosis, classification, nonoperative treatment, surgical options, complications, and recovery process for clavicle fractures. It is intended for general education and does not replace evaluation by a qualified healthcare professional.
Key Takeaways
The middle third, or shaft, is the most common location for a clavicle fracture.
Typical symptoms include pain, swelling, bruising, tenderness, and difficulty moving the arm.
Plain X-rays are the primary imaging test; CT may be used for complex, medial, or preoperative cases.
Most minimally displaced fractures are treated with a sling, follow-up imaging, and progressive rehabilitation.
Open fractures, threatened skin, neurovascular injury, an unstable shoulder girdle, and selected displaced or unstable fractures may require surgery.
Plate fixation and intramedullary fixation can both provide good outcomes in selected adult shaft fractures, but each has different advantages and risks.
Recovery varies by age, fracture pattern, treatment method, smoking status, and evidence of bone healing.
What Is a Clavicle Fracture?
The clavicle is an S-shaped bone that connects the sternum at the center of the chest to the scapula at the shoulder. It acts as a structural link between the trunk and the upper limb while helping protect the nerves and blood vessels that pass beneath it.
Clavicle anatomy and typical fracture displacement patterns.
A clavicle fracture occurs when a force exceeds the strength of the bone. Common mechanisms include a fall directly onto the shoulder, a fall onto an outstretched arm, a collision during contact sports, and higher-energy bicycle or motor vehicle trauma. In younger patients, these injuries often follow sports or traffic accidents. In older adults, a lower-energy fall may be sufficient, particularly when bone quality is reduced.
Clavicle fractures account for approximately 3% to 5% of adult fractures. The distribution is often described as bimodal, with one peak among adolescents and young adults and another among older adults.
Symptoms of a Clavicle Fracture
Symptoms depend on the location and severity of the injury, but commonly include:
Immediate pain over the collarbone after an injury
Swelling, bruising, and localized tenderness
Pain when lifting or moving the affected arm
A visible bump, step, or change in shoulder contour
A feeling of grinding or movement at the fracture site
A tendency to support the injured arm with the opposite hand
Warning Signs That Need Urgent Assessment
Urgent medical assessment is important when the skin is broken or tightly tented over a sharp fragment; the hand or arm becomes pale, cold, weak, or numb; breathing is difficult; chest pain is present; or the injury followed high-energy trauma. These findings can indicate an open fracture or an associated injury involving the lungs, chest wall, nerves, or blood vessels.
Clinical examination should include the skin, shoulder contour, circulation, and nerve function.
How Is a Clavicle Fracture Diagnosed?
Diagnosis begins with the injury history and a physical examination. The clinician assesses the location of tenderness, visible deformity, skin condition, shoulder movement, and the circulation and nerve function of the affected arm. In higher-energy injuries, the chest, neck, scapula, and other parts of the shoulder girdle also require careful evaluation.
X-Ray
Plain radiographs are the standard first-line imaging test. They confirm the fracture location and help show displacement, angulation, shortening, and comminution. Upright radiographs may demonstrate more displacement than images taken with the patient lying down, particularly in midshaft clavicle fractures.
CT and Other Imaging
Computed tomography may be useful when a fracture involves the medial clavicle or sternoclavicular joint, when the fracture pattern is complex, when associated shoulder-girdle injuries are suspected, or when more detailed preoperative planning is required. Additional imaging is selected according to the suspected associated injuries rather than used routinely for every clavicle fracture.
Radiographs help define fracture location, displacement, shortening, and comminution.
Types and Classifications of Clavicle Fractures
The most practical first step is to classify a clavicle fracture by location:
| Location | Description | Clinical Considerations |
|---|---|---|
| Midshaft fracture | Involves the middle third of the clavicle and is the most common pattern. | Displacement, shortening, comminution, skin condition, and patient activity level help guide treatment. |
| Distal clavicle fracture | Involves the lateral end near the acromioclavicular joint. | Stability depends partly on the relationship between the fracture and the coracoclavicular ligament complex. |
| Medial clavicle fracture | Involves the end next to the sternoclavicular joint and is relatively uncommon. | Posterior displacement requires careful assessment because important structures lie behind the medial clavicle. |
Common Classification Systems
The Allman system groups clavicle fractures into middle-third, distal-third, and medial-third injuries. More detailed systems include the Neer classification for distal clavicle fractures, the Robinson or Edinburgh classification, and the AO/OTA classification. These systems describe factors such as location, displacement, comminution, articular involvement, and ligament stability.
A classification name alone does not determine treatment. The clinician must also consider the skin and soft tissues, neurovascular status, associated injuries, patient age, medical condition, occupation, activity level, and treatment preferences.
Common clavicle fracture classification systems describe location, stability, displacement, and comminution.
Nonoperative Treatment of Clavicle Fractures
Most isolated clavicle fractures are managed without surgery, particularly when alignment is acceptable and the fracture is expected to remain stable. A simple arm sling is generally preferred over a figure-of-eight brace because it is easier to apply and is often more comfortable.
Nonoperative care may include:
Sling immobilization for comfort and protection
Pain management directed by a healthcare professional
Regular clinical and radiographic follow-up
Early movement of the elbow, wrist, and hand
Progressive shoulder motion when pain and fracture stability allow
Strengthening after clinical and radiographic signs of healing
The advantages of nonoperative treatment include avoiding an incision, anesthesia, infection risk, and implant-related problems. Possible disadvantages include persistent deformity, delayed union, nonunion, malunion, and a slower early return to demanding work or sports in selected displaced fractures.
A simple arm sling is commonly used for comfort and protection during early nonoperative care.
When Does a Clavicle Fracture Need Surgery?
Surgery is not required for every displaced clavicle fracture, and no single measurement should be used in isolation. Treatment should be individualized through shared decision-making between the patient and the treating surgeon.
Surgical treatment may be recommended or strongly considered when there is:
An open fracture
Skin compromise or severe tenting over a fracture fragment
Associated injury to blood vessels or nerves
An unstable shoulder girdle or selected multiple-trauma pattern
Marked displacement, shortening, or comminution in an adult midshaft fracture
An unstable displaced distal clavicle fracture with disruption of the coracoclavicular ligament complex
Symptomatic nonunion or malunion
A need to restore alignment and stability after considering occupation, sport, general health, and patient preferences
In adults with displaced midshaft fractures, operative treatment is associated with higher union rates and better early patient-reported outcomes than nonoperative care. Long-term outcomes and satisfaction, however, can be similar with either approach. The balance differs in adolescents, whose healing potential is greater and for whom routine surgery for an isolated displaced midshaft fracture may offer no clear functional advantage.
Fracture characteristics and associated injuries are considered together when deciding whether surgery may be appropriate.
Nonoperative Care vs. Surgical Fixation
| Treatment | Commonly Considered For | Potential Advantages | Potential Limitations |
|---|---|---|---|
| Sling and rehabilitation | Many nondisplaced, minimally displaced, and stable fractures | Avoids surgery and implant-related complications | Selected displaced fractures have a greater risk of nonunion, malunion, or slower early recovery |
| Plate and screw fixation | Selected displaced, shortened, comminuted, open, or unstable fractures | Direct reduction, strong fixation, and high union rates | Scar, infection, numbness, hardware prominence, and possible implant removal |
| Intramedullary fixation | Selected clavicle shaft fractures with a suitable pattern | Smaller incisions and less soft-tissue exposure in some cases | Implant irritation, migration, removal, and less suitability for some comminuted patterns |
Surgical Treatment Options
Plate and Screw Fixation
Open reduction and internal fixation with a plate is a common surgical method for clavicle fractures. The surgeon restores alignment and secures the fracture with a plate and screws. Modern orthopedic locking plate systems provide fixed-angle options for selected fracture patterns. Plate fixation can be particularly useful when the fracture is comminuted or when maintaining length and rotation is important.
Pre-contoured implants such as an S-shaped clavicle locking plate are designed to follow the curvature of the clavicle, although final implant selection and contouring depend on the individual anatomy and fracture configuration. Potential disadvantages include numbness around the incision, implant prominence, soft-tissue irritation, infection, and the possibility of a later procedure to remove symptomatic hardware. Implant removal is not automatically required after every healed fracture.
Plate fixation restores alignment and stabilizes the clavicle while the fracture heals.
Intramedullary Fixation
Intramedullary devices are inserted within the canal of the clavicle to stabilize selected shaft fractures. Compared with plating, this technique may use smaller incisions and reduce some soft-tissue exposure. However, not every fracture is suitable for intramedullary fixation, particularly when comminution makes length or rotational control difficult. Both plates and nails form part of a broader orthopedic trauma fixation system.
For adult clavicle shaft fractures, intramedullary nailing and single-plate fixation can produce similar long-term clinical outcomes and complication rates. Plate fixation may offer an advantage in the presence of comminution.
Intramedullary fixation can be considered for selected clavicle shaft fracture patterns.
Minimally Invasive Plate Osteosynthesis
Minimally invasive plate osteosynthesis uses smaller incisions and limited exposure while stabilizing the fracture with a plate. The technique aims to preserve soft tissue and fracture biology, but accurate reduction and protection of the supraclavicular nerves remain important.
Examples of minimally invasive plate fixation for clavicle fractures.
Distal Clavicle Fixation
Distal clavicle fractures require assessment of fracture location, fragment size, articular involvement, and integrity of the coracoclavicular ligament complex. Options may include a distal clavicle locking plate, coracoclavicular stabilization, or other fixation techniques selected for the specific pattern. Evidence does not support one technique for every distal fracture.
Distal clavicle fixation is selected according to fragment size and ligament stability.
Medial Clavicle Fractures
Most minimally displaced medial clavicle fractures can be managed without surgery. CT is often valuable when displacement is difficult to define or when posterior displacement is suspected. Because the trachea, esophagus, major vessels, and other mediastinal structures lie nearby, posteriorly displaced medial injuries require urgent specialist assessment.
Complex clavicle injuries may require a fixation strategy tailored to the individual fracture pattern.
Clavicle Fracture Recovery and Rehabilitation
There is no single recovery timetable for every clavicle fracture. Age, fracture location, displacement, treatment method, smoking status, associated injuries, and radiographic healing all affect progression. Many patients regain useful function within 6 to 12 weeks, but complete bone healing, strength recovery, and return to high-demand activity may take longer.
Protection phase: A sling is used for comfort and protection. Hand, wrist, and elbow motion is usually encouraged unless another injury prevents it.
Early motion phase: Gentle shoulder exercises may begin when pain decreases and the treating clinician confirms that movement is appropriate.
Strengthening phase: Resistance exercises are introduced after sufficient clinical and radiographic healing.
Return-to-activity phase: Heavy lifting, contact sports, and activities with a high risk of falling should wait until the fracture has healed and strength and motion have recovered.
Follow-up is important because increasing deformity, persistent pain, or lack of radiographic progression may indicate displacement, delayed union, or nonunion. Smoking can impair fracture healing and should be addressed as part of the treatment plan.
Possible Complications
Complications After Nonoperative Treatment
Nonunion: the fracture fails to heal, which may cause persistent pain or weakness.
Malunion: the fracture heals in a shortened, angulated, or displaced position.
Visible prominence: a bump may remain over the healed fracture.
Shoulder stiffness or weakness: rehabilitation may be required to restore function.
Neurovascular symptoms: these are uncommon but require prompt assessment.
Complications After Surgery
Wound infection
Numbness or altered sensation around the incision
Hardware irritation or prominence
Implant loosening, bending, or breakage
Delayed union, nonunion, or malunion
Refracture, including after implant removal
Need for another operation, often because of symptomatic hardware
Complication risk depends on the fracture and the patient. A higher radiographic union rate does not mean surgery is the best choice for everyone, just as avoiding surgery does not eliminate the possibility of later intervention.
Follow-up imaging can help identify healing problems and implant-related complications.
Frequently Asked Questions
Can a clavicle fracture heal without surgery?
Yes. Most isolated clavicle fractures are treated without surgery and heal with sling support, follow-up, and progressive rehabilitation. The likelihood of successful nonoperative care depends on fracture stability, displacement, comminution, location, patient age, and other clinical factors.
How long does a clavicle fracture take to heal?
Many patients regain normal or near-normal function within approximately 6 to 12 weeks, but healing time varies. Adults, smokers, people with markedly displaced or comminuted fractures, and patients with other medical conditions may need longer. Return to contact sports requires confirmed healing and medical clearance.
What is the most common type of clavicle fracture?
Midshaft clavicle fractures are the most common. Distal fractures are less frequent, and medial clavicle fractures are relatively uncommon.
Is a visible bump after a clavicle fracture normal?
A visible prominence is common during healing and may remain after the bone unites. In children and adolescents it may remodel substantially over time. A growing deformity, threatened skin, worsening pain, numbness, or weakness should be assessed promptly.
Is plate fixation better than intramedullary fixation?
Neither method is best for every patient. Both can provide good long-term results in selected adult shaft fractures. Plate fixation may be preferable for comminuted patterns, while intramedullary fixation may reduce incision size in suitable fractures. The decision depends on fracture morphology, surgeon experience, patient priorities, and implant-related risks.
Does clavicle hardware always need to be removed?
No. Plates, screws, and intramedullary devices are not routinely removed when they are asymptomatic and the fracture has healed. Removal may be considered for persistent irritation, prominence, pain, implant problems, or other clinical reasons after discussing the risks of another operation.
What are signs that a clavicle fracture may not be healing?
Persistent pain at the fracture site, ongoing movement or tenderness, limited functional improvement, and lack of progression on follow-up imaging may suggest delayed union or nonunion. These findings require assessment by the treating clinician.
Conclusion
Clavicle fracture treatment depends on more than the appearance of a single X-ray. Most stable or minimally displaced fractures can be managed successfully without surgery. Selected displaced, shortened, comminuted, open, or unstable injuries may benefit from operative fixation, particularly in adults. A careful assessment of fracture pattern, skin and neurovascular status, associated injuries, patient age, activity demands, and treatment goals is essential for shared decision-making.
