A mid-shaft clavicle fracture is a break in the middle third of the collarbone, the most common location for clavicle fractures and one of the most frequent fractures overall. Most occur from a direct fall on the shoulder or a direct blow to the bone. Historically treated non-surgically, current practice uses surgical fixation for significantly displaced fractures in active patients because it produces more reliable healing and better functional outcomes.
What Is a Mid-Shaft Clavicle Fracture?
The clavicle is an S-shaped bone that connects the sternum medially to the acromion laterally. It acts as a strut that holds the shoulder complex out from the chest wall, allowing the full range of shoulder and arm motion. The mid-shaft section is the narrowest and mechanically most stressed part of the bone, which is why it is the most common fracture location.
Fractures in this region are described by displacement, shortening, and comminution (number of fragments). Simple transverse fractures with minimal displacement heal reliably with non-surgical treatment. Fractures with more than 2 centimeters of shortening, significant displacement, or comminution into multiple fragments carry a higher risk of nonunion and malunion that impair shoulder mechanics.
Causes and Risk Factors
- Direct fall on the lateral shoulder, the most common mechanism
- Direct blow to the clavicle from contact sport or trauma
- Cycling accidents, falls from height, and motor vehicle collisions
- High-energy mechanisms that also carry risk for associated rib, lung, or shoulder girdle injury
Symptoms
- Immediate pain at the collarbone after the injury
- Visible deformity, often with a tent-like bump or step-off
- Swelling and bruising over the mid-clavicle
- Pain with any shoulder motion
- Patients often support the injured arm against the body to reduce pain
Diagnosis
Dr. Chudik’s evaluation includes the mechanism of injury, a focused examination of the clavicle and shoulder, and neurovascular assessment because of the proximity of the subclavian vessels and brachial plexus to the clavicle. X-rays confirm the fracture, measure displacement and shortening, and document comminution. Additional imaging is rarely needed unless a complex pattern or associated injury is suspected.
Treatment
Non-surgical treatment is appropriate for non-displaced and minimally displaced fractures, particularly in lower-demand patients. It involves a sling for two to six weeks, ice, analgesics, and progressive shoulder motion as tolerated.
Surgical treatment is indicated for:
- Shortening greater than 2 centimeters
- Significant displacement with no bone-on-bone contact
- Comminuted fractures in young active patients
- Open fractures or fractures with neurovascular compromise
- Fractures that fail to heal after an appropriate non-surgical trial
Dr. Chudik performs open reduction and internal fixation with a contoured clavicle plate, restoring length, alignment, and rotational position. For displaced fractures in active patients, this produces more reliable union, faster return to activity, and better functional outcomes than non-surgical treatment.
Recovery and Outcomes
Non-surgical recovery involves two to six weeks of sling use, gradual motion progression, and return to daily activities as symptoms allow. Bone union typically occurs by eight to 12 weeks. Return to contact sport is delayed until radiographic union and strength recovery are documented, usually 12 to 16 weeks.
After plate fixation, a sling is used for one to two weeks for comfort, with active motion beginning early. Return to daily activity is faster than with non-surgical treatment. Contact sport is typically allowed at 10 to 12 weeks after imaging confirms healing. Hardware irritation is the most common late complication and may prompt plate removal after union.
When to See Dr. Chudik
Schedule an evaluation after any fall or blow to the shoulder that produces immediate pain at the collarbone, visible deformity, or inability to move the arm. Call 630-324-0402 or request an appointment online.