Clavicle Fractures

Clavicle fractures are classified based on their location along the bone:

• Midshaft Clavicle Fractures – These are the most common, accounting for approximately 75-80% of all clavicle fractures. They occur in the middle portion of the bone, where the clavicle is the thinnest and most vulnerable to breakage.
• Distal Clavicle Fractures – These occur near the shoulder joint, where the clavicle meets the acromion (part of the shoulder blade). This type of fracture may involve ligament injuries and is often more complex to treat.
• Medial Clavicle Fractures – These are rare and occur near the sternum. Because of their proximity to major blood vessels and vital structures in the chest, these fractures require careful evaluation and monitoring.

The most common causes include:

• Falls – Falling onto an outstretched arm or directly onto the shoulder is one of the most common ways to break the clavicle. This is frequently seen in athletes who participate in contact sports like football, rugby, or wrestling, as well as in individuals who engage in activities with a high risk of falls, such as skiing, cycling, or skateboarding. 
• Direct Impact to the Shoulder – A direct blow to the shoulder, such as from a collision during sports or an accident, can generate enough force to fracture the clavicle. This is common in hockey, lacrosse, and martial arts, where high-impact contact is frequent.
• Motor Vehicle Accidents – In a car or motorcycle accident, the sudden force from a collision can cause the clavicle to break. The impact of the seatbelt across the shoulder or a direct blow from the dashboard during a crash can contribute to the fracture. 
• Birth Trauma in Newborns – In difficult or prolonged labor, excessive pressure on the infant’s shoulders during delivery can result in a clavicle fracture.
• Repetitive Stress Injuries – Athletes who engage in activities involving frequent overhead motions, such as weightlifting or baseball, may develop stress fractures in the clavicle due to repeated strain on the bone.

The most common signs include:

1. Immediate sharp and severe pain – The pain is usually localized to the collarbone region and may intensify with shoulder or arm movement.
2. Swelling and Bruising – Swelling develops rapidly around the fracture site, and bruising may appear within a few hours as blood vessels are damaged.
3. Visible Deformity or Bump – A displaced clavicle fracture may cause the bone to shift out of alignment, creating a noticeable bulge or abnormal contour under the skin.
4. Difficulty Moving the Shoulder – Patients with a clavicle fracture often have limited arm and shoulder mobility due to pain and instability.
5. Grinding or Clicking Sensation – Some patients report a grinding, clicking, or popping sensation when attempting to move the affected arm.
6. Sagging of the Shoulder – A clavicle fracture can lead to a noticeable drooping of the shoulder on the injured side, particularly if the break is severe.

Dr. Stephanie Boden uses a comprehensive approach that includes:

Physical Examination

A detailed physical assessment is the first step in diagnosing a clavicle fracture. The doctor will inspect the affected area for swelling, bruising, or deformities, gently palpate the collarbone to identify the exact location of tenderness and instability, assess shoulder mobility and range of motion, and evaluate circulation and nerve function in the arm to rule out associated injuries.

Imaging studies

• X-ray Imaging – A standard X-ray is the most reliable tool for confirming a clavicle fracture.
• CT scan – This scan provides a three-dimensional view of the fracture and helps in surgical planning if needed.
• MRI or Ultrasound – Although rarely required for clavicle fractures, an MRI or ultrasound may be used to assess soft tissue damage.