Shoulder Fracture – Clavicle

What Is The Clavicle?

The clavicle is the only bone connecting the shoulder blade and the arm to the central skeleton. In essence, the clavicle is like a suspension bridge between the spine’s central skeleton and the shoulder blade (scapula) and arm.

The shoulder blade and arm are actually suspended from the distal end of the clavicle. The ends of the clavicle are held in place by very strong ligaments. The inside end of the clavicle (medial) creates the sternoclavicular joint (SC joint) at the central skeleton (the sternum). The outside end (lateral or distal) creates the acromioclavicular joint (AC Joint). 

General Fracture Information :

While any bone in the shoulder can be fractured, the bone most commonly fractured is the clavicle. The next most common shoulder bone fractured is the ball (proximal humerus). The least common shoulder bone fractured is the shoulder blade (scapula).

Which fractures will heal without surgery?

In general, if the fracture has not displaced from its normal position or is minimally displaced, the fracture can be treated in a sling, and it will heal on its own. The one exception to this is for elderly patients, who have fractured a hip or leg and the shoulder. In this case, surgery for the shoulder fracture may be needed to help them get out of bed and use a walker or crutch.

Three types of fractures in the shoulder usually need surgery.

1. A fracture of the bone to which the rotator cuff tendons attach (greater or lesser tuberosity). When these fractures are displaced, the rotator cuff function is in jeopardy. These are usually treated by sewing the piece or pieces back in position. Some of these can be performed with arthroscopic assistance. Sometimes, these are fixed with pins or a screw.

2. A displaced fracture of the surgical neck. If the humeral shaft and ball are out of alignment or not in at least 50-percent contact, the bone may heal in a bad position or not heal at all. These are usually fixed with a plate and screws or pins.

3. A fracture that displaces the joint surface. A fracture of the ball (humeral head) that is displaced can severely affect how the shoulder works and can lead to deterioration of the joint.

Some of these fractures can be fixed with a plate and screws. Some require a partial joint replacement.

How does the clavicle get broken?

The clavicle is also known as the “collarbone”. A direct fall on to the shoulder is the most common way to break the collarbone. Most fractures of the collarbone will heal well on their own. However, there are certain types of fractures that will need surgery to heal well. 

When is Surgery Required?

Immediate surgery is needed when there is a break in the skin over the fracture, or the edge of the fracture is putting pressure on the skin, or there are nerve symptoms from pressure caused by the fracture. Fortunately, this is very uncommon.

More commonly, surgery is needed when the gap between the pieces is too large, or the overlap of the pieces is too great. If the gap between pieces is too large, the fracture may take a very long time to heal or not heal at all.

Rather than investing four to six months of time to see if a fracture will heal, it is more predictable to have surgery. During surgery, the gap is reduced and the pieces of the fracture are held together with a plate and screws. This aids the body in efficiently completing the healing process.

If the overlap of the pieces is too great, the fracture may heal in a position that makes the collarbone much shorter. This can prevent the shoulder from functioning normally. First, it can affect the range of motion of the shoulder.

Second, it can affect the strength of the shoulder. In some cases of overlap, the pieces heal and create a larger mass of bone. This larger mass of bone can push on the important nerves below the collarbone. These nerves operate the muscles and sensations of the shoulder, arm, and hand. Normally, the collarbone protects these nerves. But if the mass of bone is too large, the nerves can be injured.

Occasionally, an athlete will have surgery on a fracture expected to heal well. This is done to ensure that they return to their sport as quickly as possible. High-level cyclists are the most likely to request this. This is a very special situation and requires an in-depth evaluation of the athlete’s situation, because it carries some extra risks. Consult your shoulder specialist for more information.

Why are Plates & Screws Used In Surgery?

Today, the technology for fixing these fractures is very good. Special plates shaped to match the collarbone have improved the results of surgical treatment greatly. These plates and screws are the strongest way to hold the pieces of the fracture together. By holding the pieces together, the body can efficiently go through the healing process Today’s plates are very smooth and thin. They are rarely felt under the skin, and rarely need to be removed after the healing.