A distal clavicle fracture is a fracture (break) in the distal third, closer to the shoulder, of the clavicle (collarbone). It occurs after a specific injury and can initially be mistaken for an acromioclavicular sprain (“separated shoulder”) on physical examination.
What Is a Distal Clavicle Fracture?
A distal clavicle fracture is a break in the distal third of the clavicle (collarbone), closer to the shoulder.
Most displaced distal clavicle fractures do not heal on their own without surgical intervention. They are associated with injury to the coracoclavicular ligaments, which can allow significant displacement and non-healing of the fracture.
Significantly displaced and open fractures, where the bone breaks through the skin, require surgery to prevent infection, restore proper bony alignment of the clavicle, and promote healing.
Causes and Risk Factors
Common causes include:
- Impact or falling on the tip of the shoulder
- A direct blow to the clavicle
- Less commonly, an indirect stress such as falling on an outstretched hand or on the tip of the elbow
Risk factors include:
- Contact or collision sports such as football, soccer, hockey, and rugby
- Sports with a high risk of falling on the shoulder, such as rodeo riding, mountain bike riding, or cycling
- Inadequate protective equipment
- A history of bone or joint disease, especially osteoporosis
Symptoms
Signs and symptoms may include:
- A deformity or bump if the fracture is complete and the bone fragments separate enough to change the normal appearance of the top of the shoulder
- Pain, tenderness, and swelling at the fracture site
- Bruising at the site of injury
- Loss of strength or pain when attempting to use the affected arm
- Numbness or coldness in the affected shoulder and arm if the blood supply is impaired or nerves are injured, which is rare
- Less commonly, shortness of breath or difficulty breathing
Treatment
For minimally displaced clavicle fractures, initial treatment consists of ice, a compressive dressing, and over-the-counter medication to relieve pain and reduce swelling. An arm sling or shoulder immobilizer is usually recommended.
Patients should avoid risky activities, including sports, overhead work, and smoking, until the fracture is healed, usually at least six or more weeks. Pain typically subsides after two to four weeks as the fracture begins to heal, allowing the arm to be used more comfortably for activities of daily living that do not involve overhead motion.
For significantly displaced fractures, open fractures, or fractures associated with neurovascular injury and multiple injured extremities, surgery is recommended. Surgery can stabilize the fracture in the proper position to allow bone healing and early mobilization.
Surgery consists of making incisions, repositioning the fracture fragments, and holding them in place with plates, screws, wires, sutures, or pins. After fracture healing, these fixation devices may be removed if needed.
Recovery and Outcomes
Exercises to regain shoulder motion and strength lost as a result of the injury and healing process are necessary before returning to sports and activities. These exercises may be performed independently, or patients may be referred to a physical therapist or athletic trainer for further evaluation and treatment.
Return to sports requires healing of the bone and usually takes three to six months, depending on the patient’s age and the severity of the fracture.
Most displaced distal clavicle fractures do not heal on their own without surgical intervention. Significantly displaced and open fractures require surgery to restore proper bony alignment and promote healing. Lifestyle factors such as smoking can also prevent normal healing.
When to See Dr. Chudik
Consider an evaluation following a shoulder injury that causes pain, tenderness, swelling, bruising, deformity, or difficulty using the affected arm. Call 630-324-0402 or request an appointment online.