A: The clavicle, or collar bone, is the long curving bone connecting the sternum (breast bone) to the shoulder. In fact, it is the only real bony connection between the arm and the rest of the body. A number of ligaments attach to the clavicle to connect the clavicle to the scapula (shoulder blade), the sternum (breast bone), and the ribs.

Q: How Common is a fractured Clavicle? How does it usually Happen ?

A: Fractures of the clavicle are among the most common fractures seen by physicians-making about 5% of all fractures. Most commonly the fractures is due to fall on an outstretched hand, or a direct hit to the clavicle. It one of the most common fractures sustained while cycling, usually from a fall off the bike onto the pavement.

A: The clavicle can be broken in three different regions, and the symptoms vary according to the site:

Fracture of the Middle 1/3

Usually this causes pain with any movement of the shoulder. Often the injured individual will hold the arm against the chest to prevent motion. Often there is an obvious change in shape of the affected shoulder, the shoulder moving downward and backward. The clavicle may be extremely tender over the site of fracture. In some cases, there may be motion or creaking (crepitus) at the site of fracture. Bruising over the skin is common.

Fracture of the Distal 1/3

These fractures may be subtle, and are often overlooked. They may also be confused with a separated shoulder (acromioclavicular separation). Pushing on the joint between the end of the clavicle and the shoulder (AcromioClavicular or A-C joint) may cause pain. Pain with arm movement, and skin bruising may also appear.

Fracture of the Proximal 1/3

In this fracture, pain, tenderness, and swelling are located over the sternum (breast bone). Once again, any shoulder movement will cause pain, and injured persons are most comfortable sitting quietly with the arm held. If the joint between the clavicle and sternum is disrupted (sternoclavicular dislocation) the usual bump at this junction may be lost.

Q: What is the best test to check for a fractured clavicle?

A: In almost all cases, Xrays of the clavicle from two separate directions - AnteroPosterior and 45 degree cephalic tilt - will show the fracture. In some cases of distal or proximal clavicle fractures, it may be difficult to see the fracture line. In these cases CAT scan or MRI (magnetic resonance imaging) may be needed.

Q: When a friend fractured his clavicle a few years ago, he was given a sling and told the fracture would heal on its own. However, I've heard of other people who need surgery for a broken clavicle. Why is there so much difference in the way certain doctors treat this when compared to others?

A: Treatment of clavicle fractures varies widely between the various types of fractures--from a simple sling to surgical operation. Although the topic is complex, in general treatment is as follows:

Fractures of the middle 1/3

Treatment of these fractures is usually quite simple. In order to minimize the movement of the two pieces of bone to promote good healing some sort of support is usually needed. A sling may be sufficient in the fracture is not displaced. However, often a bit more support is needed and a "figure 8" splint is needed. This holds the shoulders in the position of attention , and is intended to hold the two ends of the fractured clavicle together.

Generally, the splint is necessary for 4 to 8 weeks in adults, and 3 to 6 weeks in children. A repeat Xray is often performed at 6 weeks to assess healing.

While healing is taking place, the person may use the arm as needed, but should avoid contact sports or lifting the arm high above the head.

Fractures of the distal 1/3

Treatment of these fractures may be more complex, and depends on the exact type and location of the fracture:

Type I

This is the most common distal clavicle fracture. in this case the supporting ligaments remain strong, and the fracture remains well immobilized.

Generally, these can be treated with an arm sling for 3 to 6 weeks, or until pain subsides. Activity can gradually be increased as pain allows, but contact sports should be avoided for 2 to 3 months to avoid re-injury.

Type II

In this fracture, the distal tip of the clavicle remains attached to the shoulder via strong ligaments (coracoclavicular ligament) while the more proximal fragment displaces upward.

Type II fractures should be seen by an orthopedic surgeon, and surgery is often necessary to rejoin the two fragments. Following surgery, the shoulder is put in a sling and swathe for 6 to 8 weeks. Once again potential for re-injury should be minimized for several months.

Type III

The fracture line in this cases passes directly into the joint between the clavicle and shoulder (acromioclavicular joint).

Type III fractures are treated with a sling as in type I, and with the same activity precautions.

In type III fractures, arthritis may develop long after the actual accident. In this case, physiotherapy and anti-inflammatories may be needed. In cases of severe arthritis, referral to a surgeon may be necessary for removal of the tip of the collarbone (distal clavicle resection).

Fractures of the Proximal 1/3

These are generally treated with an arm sling for comfort measures, for 3 - 6 weeks. The arm can be used as the pain permits, with avoidance of contact sports for 1 to 2 months.

In general, fractures tend to heal much more quickly, and with a better functional and cosmetic results in children as compared to adults