Get to know the clavicle

The clavicle or collarbone is located between the ribcage (sternum) and the shoulder blade (scapula). The clavicle is a large doubly curved long bone that connects the arm to the body. It functions as a strut to support the shoulder and arm, allowing for a full range of motion of the arm.

In addition, the clavicle lies above several important nerves and blood vessels, therefore it protects these nerves and blood vessels from injuries, starting in the neck and running through the armpit.

Causes of clavicle fracture

A clavicle fracture is a break in the collarbone. This type of fracture is fairly common since the clavicle acts to transmit forces from the upper limb to the body. Clavicle fractures can be caused by either direct or indirect trauma. Clavicle fractures occur directly when direct force is applied to the clavicle. Quite often, clavicle fractures happen due to indirect trauma, for instance, when a fall onto the shoulder or an outstretched arm causing a compressive force across the clavicle and making the clavicle snap or break.

Diagnosis

During physical examination, the physician needs to know how injury has occurred. In a clavicle fracture, there is usually an obvious deformity or bump present with swelling, pain or tenderness over the clavicle at the fractured site after injury. Diagnostic test used to confirm the clavicle fracture is imaging tests such as X-ray. A computerized tomography (CT) scan to visualize the fractures in better details might be additionally considered in some cases.

Treatments

Most fractures occur in the middle portion (or shaft) of the bone. Occasionally, the bone breaks where it attaches at the ribcage or shoulder blade. Nevertheless, clavicle fractures widely vary. The bone can only crack slightly or completely break into several pieces (known as comminuted fracture). The broken pieces of bone may line up straight or may be far out of place, called displaced fracture. If the broken ends of the bones have not significantly shifted out of place, it can be treated by non-surgical approaches such as wearing an arm sling to keep the arm and shoulder from moving while the bone heals. In general, this supportive sling needs to be worn 6-8 weeks to complete the bone healing process. To keep affected clavicle stabilized during the first 2 weeks, patients are strictly advised to refrain from moving arms or shoulders. After 2 weeks, moving arm and shoulder can be gradually resumed in order to minimize stiff shoulder and increase movement flexibility. Follow-up appointments will be frequently made to monitor treatment outcomes and imaging tests might be occasionally required to ensure the bone heals in a proper position.

With some other forms of clavicle fracture, however, the pieces of broken bone might be shifted out of place, greater than 2 cm. apart or the length might become shorter. For these complicated fractures, surgery may be needed to realign the broken clavicle. Surgery typically involves putting the broken pieces of bone back into normal position and preventing them from dislocation until they are completely healed. Due to advanced techniques, surgery with reduction and fixation can significantly help enhancing bone healing process while minimizing the chance of deformity or malalignment. To treat clavicle fractures, a minimally invasive plate osteosynthesis or MIPO has been evolved and considered an effective surgical technique. During MIPO, 2-3 small incisions are made. Through these small incisions, the bone fragments are held in place with special screws and metal plates without having a large open incision along the length of the clavicle. Superior advantages over conventional approach are seen as MIPO technique does not interfere with the fractured site and therefore provides improved biological healing while preserving surrounding tissues and nerves. More importantly, this minimally invasive technique substantially reduces pain and post-operative complications, allowing the patients to recover faster with a quick return to their daily lives and activities.

Possible complications

In some cases with non-surgical treatments, possible complications involve incomplete bone healing or healing with deformity, resulting in limited movement of arm or shoulder, especially if the fracture fragments have been shifted apart. In patients who underwent surgery with plate and screw placement, common complication might involve numbness at the surgical site on the upper chest. Although a palpable bump over the fracture site may develop as the fracture heals, surgery using plates and screws substantially enhances proper bone healing process and reduces the chance of malalignment or deformity. To achieve the best possible outcomes and minimize undesired effects, treatment should be performed based primarily on indications and treatment protocols. More crucially, depending on severity and individual conditions, a customized treatment plan should be mutually agreed by both patients and orthopedic surgeons to delivery patient‐engaged care with satisfying results.