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Types

• Sternoclavicular Fracture or Fracture-Dislocation: This involves a break in the part of the clavicle where it connects to the sternum. The fracture may affect the sternoclavicular joint and often involves the growth plate.

• Clavicle Shaft Fracture: This is a break in the middle section of the clavicle and is the most common type, occurring in 80-90% of cases.

• Distal or Lateral Clavicle Fracture: This type affects the end of the clavicle near the shoulder and the acromioclavicular (AC) joint. The fracture may extend into the growth plate or the AC joint.

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Symptoms

Clavicle fractures often result from a significant fall or collision involving the shoulder. Common symptoms include pain, swelling, and difficulty lifting the arm. A crack or popping sound may be heard at the time of injury. If these symptoms are present after a fall or collision, an X-ray should be obtained to confirm the diagnosis.

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Diagnosis & Treatment

Examination

During the examination, the doctor will check for swelling, bruising, and tenderness around the clavicle. They will also assess the skin to ensure there are no open fractures or signs of skin "tenting," where the skin might be stretched tightly over the broken bone. Additionally, the doctor will examine the function of the muscles, nerves, and circulation in the arm. Open fractures and skin tenting are rare with clavicle fractures.

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X-Rays and Tests

X-rays are typically used to diagnose clavicle fractures. In some cases, a CT scan may be ordered for a detailed view of the joint surface or growth plates if the fracture is at either end of the bone.

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Non-Operative Treatment

Treatment depends on the type and severity of the fracture. Most clavicle fractures in children can be managed with a shoulder sling and rest. 

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In older adolescents, there is ongoing debate about the benefits of surgical intervention for complete fractures with significant displacement, as studies have shown mixed results. While surgery may benefit adults with severe fractures, recent research suggests that the risks might outweigh the benefits for adolescents. Discussing options with an orthopedic surgeon is recommended to determine the best approach for long-term shoulder health.

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During the initial two weeks after the fracture, pain management with a shoulder sling is important. Follow-up X-rays may be taken 2-4 weeks post-injury to monitor healing. As pain subsides and movement improves, the sling may no longer be needed at home, but it might still be recommended at school to remind the patient and others of the activity restrictions. Full return to sports and normal activities typically occurs 2-3 months after the injury.

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Operative Treatment

Surgery may be necessary for clavicle fractures if there is significant skin stretching by broken bone edges or if the fracture shows no signs of healing, though this is rare. Surgical treatment usually involves a single incision below the clavicle and the placement of a metal plate and screws to stabilize the fracture. While this method is effective, some adolescents may experience discomfort from the hardware, occurring in 5-20% of cases. If this occurs, a minor procedure to remove the plate and screws can alleviate the pain. It is important to avoid contact sports for several months post-surgery to prevent re-injury until the bone fully heals.

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Outcomes

Most children recover fully from clavicle fractures within a few months. A sling is typically used for 2-8 weeks, and arm function generally returns to normal with gradual resumption of strength exercises. Advanced healing of the bone takes around 3 months. Activities with a high risk of falls or contact sports should be postponed until follow-up X-rays confirm that the bone has healed sufficiently.

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Children require specialized care, and a pediatric orthopedic surgeon is best equipped to ensure proper alignment, reduce complications, and achieve a favorable outcome.

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