Clavicle/Collarbone Injury

Clavicle injuries can be very complicated, and they are quite common in motor vehicle accidents. Collarbone fractures are particularly common in pedestrian accidents, bicycle accidents, and motorcycle accidents. The collarbone is a relatively weak bone and will fracture with fifteen pounds of sudden traumatic force. A clavicle fracture is properly characterized as a chest injury. However, the clavicle articulates from the sternum to the shoulder, and because injury to this bone is quite common, we consider these injuries separately.

In cases involving hairline fracture or non-displaced fracture, inactivity and proper splinting are often sufficient to promote a full recovery. However, if the collarbone is broken into separate pieces, repair and recovery can be extremely complicated. The obvious symptom of a displaced, nonunion fracture would be significant dropping of the shoulder and arm. A figure-eight brace loops under the arm and also around the neck and is used to apply pressure to the underside of the arm, pulling it upward toward the patient’s neck. In my experience, physicians may rely on bracing too often in displaced fracture cases. The more certain repair would be surgery either to the repair the bone from the outside with a plate and screws or from the inside with a rod that is later removed once the bone heals sufficiently and in proper anatomic alignment.

If a displaced collarbone fracture is not surgically repaired, the bones occasionally will not properly rejoin. Instead, a fibrous union develops between the bones, creating a “false joint.” With this healing, there is a hinge point in the shaft of the clavicle, allowing movement that would otherwise be prevented by the collarbone. In all clavicle fracture cases, careful diagnostic studies should be undertaken for the entire joint structure of the shoulder. Trauma sufficient to break the collarbone can also affect the ligaments and joint structure of the shoulder on the same side.

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