The common name for the clavicle is the collar bone. This bone serves to cover and protect the brachial plexus, which is a structure made of several nerves that are responsible for the sensaton and motor function of each arm. The clavicle also acts as a strut that provides the only bony connection between upper limb (arm) and the thorax (chest). It is the first bone in the body to ossify (calcify) in a person’s early developmental stages.
Most people who have fractured their clavicle do not need surgery (Figure 1).
Figure 1. Conservative treatment of a clavicle fracture with a shoulder immobilizer. An arm sling or a figure-of-eight brace are also commonly used for nonsurgical treatment of this problem.
When an orthopaedic surgeon is evaluating a clavicle fracture he or she tries to classify the type of fracture into one of three groups.
When an orthopaedic surgeon is evaluating a clavicle fracture he or she tries to classify the type of fracture into one of three groups:
Group II: the clavicle is fractured at the distal third of the bone (toward the shoulder). This fracture pattern accounts for 10-15% of all clavicle fractures. Group II fractures may be subdivided into three separate types:
When treated nonoperatively, a patient will often wear a shoulder immobilizer, sling or a figure-of-eight brace for comfort while the bone heals (Figure 1). It is difficult to reduce and maintain the reduction of clavicle fractures; in other words, it is difficult to hold the two ends of the broken bone together in perfect alignment. Despite this, healing usually proceeds rapidly.
It is very common for the patient to be left with a prominent bump where the fracture has healed due to the bony callus that is produced during the healing process. Almost all patients do well functionally despite this bump. It may be possible to prevent formation of the bump by fixing the bone surgically with a plate and screws. However, this simply trades one cosmetic deformity (the prominent bump) for another (a surgical scar), and it subjects the patient to the risks associated with the anesthesia that must be administered in order to to perform the procedure.
A physician is likely to recommend surgery (Figure 2) when:
A floating shoulder variant. In this case, the ligaments appear to be intact, but there is a fracture of the clavicle and the scapular neck. This patient’s shoulder displaced after one week of conservative treatment in a sling, thus requiring surgical treatment.
Figure 2. Open reduction and internal fixation of a clavicle fracture with a plate and screws.