Clavicle Fracture (Collar Bone)
Photo by @harlsta
Clavicle Fracture, Broken Collar Bone
Mechanism of Injury
Typically occurs with a direct force to the outside aspect of the shoulder or a direct impact to the front of the shoulder, such as a fall directly to the ground. The injury usually occurs to shaft of the bone with the middle of the shaft being most common. A great example is when a quarterback's shoulder is driven in to the ground such as similar to what happened with Aaron Rodgers and Tony Romo.
Exam and Evaluation
Athletes will typically have swelling over the clavicle and front of the shoulder. Additionally, they will often have a clear deformity to the bone either to the touch or direct visualization. Very young children may maintain their rage of motion, however most individuals will not be able to lift the arm out in front of them or out to the side. They may also appear slumped or leaned to the injury side which tends to reduce the pull of the neck muscles on that area. An x-ray is the optimal test to confirm the diagnosis.
The treatment depends on a few key aspects of the fracture. In my opinion, the most important factor is the age of the patient. Children who have not entered puberty almost never need surgery with the exception of when the bone is sticking out of the skin, which is called an open fracture. The other factors that play a role include significant overlap of the two bones, presence of multiple fragments as well as if the fracture is open. It is generally accepted that if the two pieces of the fracture overlap more than 2 cm or if the fracture is open then surgery is recommended. However, I have personally seen cases of significant overlap that have done well and had a full return to sport with no issues. Non-operative treatment consists of sling immobilization. If surgery is chosen typically a metal plate (bar) is used to attach the pieces together.
Return TO Play
Return to play after a fracture varies significantly based on the severity of the fracture and the overall health of the individual. In a young and healthy individual, typical healing time is estimated to be around 8 -10 weeks if treated non-surgically. Usually, a sling is used for about 4 weeks and the athlete will be able to return to non contact physical activity such as weight lifting and cardio. Surgical repair can reduce the length of time to return to about 6 weeks.
Once a clavicle fracture has fully healed an athlete should have no significant impairments in sports as the bone is not actually involved in the ball and socket shoulder joint. On a side note, many people may feel surgery can get them back to playing more quickly, however one must consider the consequences of having a metal plate on your collar bone. Some individuals do not like the plate or feel that cosmetically it is unacceptable and have to have the plate removed in the future.
Photo by Lee Down
DISTAL SHAFT CLAVICLE FRACTURE
Photo by j bizzie