Clavicle (Collarbone) Fractures
Evidence-based guide to diagnosis, treatment options, and recovery
Understanding Clavicle Fractures
The clavicle (collarbone) is the most commonly fractured bone in the body, accounting for 2.5-5% of all fractures. It connects the arm to the body and protects vital structures underneath.
Epidemiology: Peak incidence in young males (sports/accidents) and elderly females (falls). 80% occur in the middle third (midshaft), 15% in the lateral (distal) third, and 5% in the medial third.
Mechanism: Most commonly from a fall onto the shoulder (87%) or direct blow. The classic presentation is a painful, swollen, drooping shoulder after trauma.
Classification (Allman/Neer)
• Most common location
• Good healing potential
• Usually non-operative
• Surgery if displaced >2cm
• Higher nonunion rate
• May involve AC joint
• Type II most unstable
• Often needs surgery
• Least common
• Usually stable
• Near vital structures
• Mostly non-operative
Treatment Options
Treatment based on Canadian Orthopaedic Trauma Society (COTS) trial, Edinburgh studies, and AAOS guidelines.
Indications: Non-displaced or minimally displaced fractures, medial third fractures, patients with low functional demands, or high surgical risk.
Protocol:
• Sling for comfort (2-4 weeks)
• Early gentle range of motion as pain allows
• Progressive strengthening from 6 weeks
• Full activity by 12 weeks if healed
Success Rate: 85-95% union rate for appropriately selected cases. Most patients return to full function.
Indications:
• Displaced midshaft fractures (>2cm shortening)
• Open fractures or skin tenting
• Neurovascular compromise
• Floating shoulder (ipsilateral scapula neck fracture)
• Distal clavicle fractures with CC ligament disruption
Surgical Options:
• Plate Fixation: Superior or anteroinferior plating. Gold standard for displaced midshaft fractures. 95-98% union rate.
• Intramedullary Fixation: Titanium elastic nail or rigid nail. Less soft tissue stripping. Good for simple patterns.
Potential Complications
• Nonunion: 15-20% (displaced fractures)
• Malunion with shortening
• Cosmetic bump
• Persistent pain (rare)
• Nonunion: 2-5%
• Infection: 1-2%
• Hardware irritation: 10-30%
• Scar (visible location)
Scientific References
1. Canadian Orthopaedic Trauma Society (COTS). Nonoperative vs operative treatment of displaced midshaft clavicle fractures. JBJS 2007
2. Robinson CM. Fractures of the clavicle in the adult. JBJS Br 1998
3. McKee MD, et al. Operative versus nonoperative care of displaced midshaft clavicular fractures. JBJS 2012
Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)
