Clavicle fracture (broken collarbone)

The clavicle connects the shoulder to the chest and is the bone most often broken in falls onto the shoulder — from bicycles, in contact sports, and in motor vehicle collisions. Most fractures occur in the middle third of the bone; fractures near the shoulder end of the bone behave differently and are assessed for AC joint involvement.

What determines treatment is not simply that the bone is broken, but how the fracture has displaced. A fracture whose fragments remain aligned heals predictably in a sling. A fracture that is significantly shortened, widely separated or broken into multiple fragments heals less reliably and with a greater chance of lasting weakness and deformity.

Symptoms are usually obvious at the time of injury and localize to the collarbone itself.

Any suspected clavicle fracture should be evaluated promptly — ideally within days of the injury. Most patients are first seen in an emergency department with a sling; the follow-up visit confirms the fracture pattern, decides between sling treatment and surgery, and sets the follow-up schedule. Fractures that are tenting the skin, associated with numbness or tingling in the arm, or clearly deformed should be assessed urgently.

Fractures initially treated in a sling that remain very painful, or whose position has shifted on follow-up X-rays, also warrant review — the decision about surgery is easiest in the first few weeks after injury.

Examination confirms the location of the fracture and checks the skin over it, along with nerve and blood vessel function in the arm. X-rays define the fracture pattern, the degree of displacement and shortening, and whether the AC or sternoclavicular joints are involved. A CT scan is added occasionally for complex patterns or fractures near the joints.

The majority of clavicle fractures are treated in a sling worn for comfort over the first few weeks, with gentle motion of the elbow, wrist and hand from the start. Interval X-rays confirm the fracture is holding its position as it heals, and range-of-motion exercises begin once early healing is established.

Structured return of strength and function follows the rehabilitation protocols, and most patients return to unrestricted activity within a few months.

Surgical fixation is considered for fractures that are significantly displaced or shortened, fractures with multiple fragments, open fractures, and fractures that threaten the skin. In these patterns, fixing the fracture with a plate and screws restores the length and alignment of the bone and lowers the risk of healing in a position that leaves the shoulder weak or deformed.

Surgery is performed as an outpatient procedure. The plate holds the fracture while it heals, and motion begins early because the fixation is stable. For athletes and heavy laborers with displaced fractures, the trade-offs of fixation versus sling treatment are discussed directly, since both are defensible for some patterns.

Dr. Horner is a board-certified orthopedic surgeon fellowship-trained in shoulder surgery and sports medicine at Rush University Medical Center, with experience caring for professional and amateur athletes — where clavicle fractures are common. The recommendation between sling and surgery is made on the fracture pattern and the demands of your work and sport, not on a default to operate.

Patients are seen at Oak Brook on Mondays, Little Village on Wednesdays and St. Charles on Thursdays.