{{Infobox medical condition | name = Clavicle fracture | synonyms = Broken collarbone<ref name=OI2016/> | image = Clavicle_Fracture_Left.jpg | caption = X-ray of a left clavicle fracture | pronounce = | field = Emergency medicine | symptoms = Pain, deformity of clavicle bone, decreased ability to move the affected arm<ref name=OI2016/> | complications = Unpleasant appearance, non-union (failure of fracture healing), open fracture, Pneumothorax, injury to the nerves or blood vessels in the area,<ref name=AFP2008/> | onset = Sudden<ref name=Pal2012/> | duration = | types = Type I (middle third of bone), Type II (lateral third of bone), Type III (medial third of bone)<ref name=Pal2012/> | causes = Fall onto a shoulder, outstretched arm, or direct trauma<ref name=OI2016/><ref name=Pal2012/> | risks = | diagnosis = Based on symptoms, confirmed with X-rays<ref name=AFP2008/> | differential = | prevention = | treatment = Pain medication, sling, surgery<ref name=OI2016/><ref name=AFP2008/> | medication = | prognosis = Up to five months for complete healing depending on treatment course (non-operative vs operative) and presence of complications <ref name=Pal2012/> | frequency = 5% of adult fractures, 13% of children's fractures<ref name=OI2016/><ref name=Pal2012/> | deaths = }} <!-- Definition and symptoms -->
A '''clavicle fracture''', also known as a '''broken collarbone''', is a partial or complete break of the clavicle bone.<ref name="OI2016">{{cite web|title=Clavicle Fracture (Broken Collarbone)-OrthoInfo - AAOS|url=http://orthoinfo.aaos.org/topic.cfm?topic=a00072|website=orthoinfo.aaos.org|access-date=26 September 2017|date=Dec 2016|url-status=live|archive-url=https://web.archive.org/web/20170904201239/http://orthoinfo.aaos.org/topic.cfm?topic=a00072|archive-date=4 September 2017}}</ref> Symptoms typically include pain and tenderness at the site of the break and a decreased ability to move the affected arm.<ref name=":1">{{Cite journal |last1=Wright |first1=Melissa |last2=Della Rocca |first2=Gregory J. |date=2023-09-15 |title=American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary on the Treatment of Clavicle Fractures |url=https://journals.lww.com/10.5435/JAAOS-D-23-00472 |journal=Journal of the American Academy of Orthopaedic Surgeons |language=en |volume=31 |issue=18 |pages=977–983 |doi=10.5435/JAAOS-D-23-00472 |pmid=37432981 |issn=1067-151X|url-access=subscription }}</ref> Other symptoms may also include reports of a cracking sensation during the injury, swelling, and deformity over the injury site.<ref name=":2">{{Cite journal |last1=Serpico |first1=Mark |last2=Tomberg |first2=Spencer |date=November 2021 |title=The emergency medicine management of clavicle fractures |url=https://linkinghub.elsevier.com/retrieve/pii/S0735675721004940 |journal=The American Journal of Emergency Medicine |language=en |volume=49 |pages=315–325 |doi=10.1016/j.ajem.2021.06.011 |pmid=34217972 |url-access=subscription }}</ref> Complications can include a collection of air in the pleural space surrounding the lung (pneumothorax), injury to the nerves or blood vessels in the area, and an unpleasant appearance.<ref name="AFP2008" />
<!-- Cause and diagnosis --> It is most often caused by a fall directly onto a shoulder, direct trauma to the bone, or a fall onto an outstretched arm.<ref name="OI2016" /><ref name="Pal2012" /><ref name=":3">{{Cite book |last1=Egol |first1=Kenneth A. |title=Handbook of fractures |last2=Koval |first2=Kenneth J. |last3=Zuckerman |first3=Joseph D. |date=2020 |publisher=Wolters Kluwer |isbn=978-1-4963-0103-1 |edition=Sixth |location=Philadelphia |pages=139–144}}</ref> The fracture can also occur in a baby during childbirth.<ref name="OI2016" /> Rare causes of clavicle fractures include muscle contractions during seizures and minimal trauma in the setting of pathologic bone conditions.<ref name=":3" /> The middle section of the clavicle is most often involved.<ref name="Pal2012" /> Diagnosis is typically based on symptoms and trauma then confirmed with X-rays.<ref name="AFP2008" />
<!-- Treatment --> Clavicle fractures can be treated operatively or non-operatively. Operative treatment involves alignment and stabilization of the fracture with plates and screws or an intramedullary device.<ref name=":1" /> Non-operative treatment consists of immobilization by putting the arm in a standard sling for three to four weeks.<ref name=":2" /> Pain medication such as paracetamol (acetaminophen) may be useful.<ref name="OI2016" /> It can take up to five months for the strength of the bone to return to normal.<ref name="Pal2012" /> Reasons for surgical repair include an open fracture, involvement of the nerves or blood vessels, tenting of the skin, or severe displacement in a high-demand individual<ref name="OI2016" /><ref name=":2" /><ref>{{cite journal | vauthors = Ropars M, Thomazeau H, Huten D | title = Clavicle fractures | journal = Orthopaedics & Traumatology, Surgery & Research | volume = 103 | issue = 1S | pages = S53–S59 | date = February 2017 | pmid = 28043849 | doi = 10.1016/j.otsr.2016.11.007 | doi-access = free }}</ref>
<!-- Epidemiology --> Clavicle fractures most commonly occur in people under the age of 25 and those over the age of 70.<ref name=AFP2008>{{cite journal | vauthors = Pecci M, Kreher JB | title = Clavicle fractures | journal = American Family Physician | volume = 77 | issue = 1 | pages = 65–70 | date = January 2008 | pmid = 18236824 }}</ref><ref name=Pal2012/> Among the younger group males are more often affected than females.<ref name=Pal2012/> In adults they make up about 5% of all fractures while in children they represent about 13% of fractures.<ref name=OI2016/><ref name=Pal2012>{{cite journal | vauthors = Paladini P, Pellegrini A, Merolla G, Campi F, Porcellini G | title = Treatment of clavicle fractures | journal = Translational Medicine @ UniSa | volume = 2 | pages = 47–58 | date = January 2012 | pmid = 23905044 | pmc = 3728778 }}</ref>
==Signs and symptoms== * Pain, particularly with arm movement or on the front part of upper chest<ref name=":2" /> * Swelling<ref name=":2" /> * Deformity of the clavicle area sometimes with a sharp bone end pressing up from below the skin creating the appearance of a tent held up by poles (skin tenting)<ref name=":2" /> * Often, after the swelling has subsided, the fracture can be felt through the skin * Sharp pain when any movement is made<ref name=":2" /> * Referred pain: dull to extreme ache in and around clavicle area, including surrounding muscles<ref name=":2" /> * Possible nausea, dizziness, and/or spotty vision due to extreme pain<ref name=":2" /> * Tachypnea (rapid breathing) if the underlying lung is affected (pneumothorax)<ref name=":2" /> * Arm weakness if the underlying neurovascular structures are damaged (brachial plexus injury)<ref name=":2" />
==Mechanism== thumb|Human skeleton viewed from the front and slightly above with clavicles shaded red Clavicle fractures are usually a result of injury or trauma. The most common mechanism involves a fall directly onto the shoulder (87%), with less common causes including direct impact to the clavicle (7%), or as a result of a fall onto an outstretched hand (6%).<ref name=":1" /><ref name=":2" /><ref name=":3" /> Falling directly on the shoulder or falling on an outstretched arm can transmit forces through the clavicle which acts as a strut between the bones of the arm and the trunk.<ref name=":3" /> The muscles involved in clavicle fractures include the deltoid, trapezius, subclavius, sternocleidomastoid, pectoralis minor, and sternohyoid. The ligaments involved include the conoid ligament and trapezoid ligament. Incidents that may lead to a clavicle fracture include automobile accidents, biking accidents (especially common in mountain biking), vertical falls on the shoulder joint, or contact sports such as football, rugby, hurling, or wrestling.<ref>{{Cite journal |last=Robinson |first=C. M. |date=1998-05-01 |title=Fractures of the clavicle in the adult: EPIDEMIOLOGY AND CLASSIFICATION |url=https://boneandjoint.org.uk/Article/10.1302/0301-620X.80B3.0800476 |journal=The Journal of Bone and Joint Surgery. British Volume |language=en |volume=80-B |issue=3 |pages=476–484 |doi=10.1302/0301-620X.80B3.0800476 |issn=2049-4408}}</ref> Newborns may present clavicle fractures following a difficult delivery involving shoulder dystocia.<ref>{{Cite journal |last1=Tsikouras |first1=Panagiotis |last2=Kotanidou |first2=Sonia |last3=Nikolettos |first3=Konstantinos |last4=Kritsotaki |first4=Nektaria |last5=Bothou |first5=Anastasia |last6=Andreou |first6=Sotiris |last7=Nalmpanti |first7=Theopi |last8=Chalkia |first8=Kyriaki |last9=Spanakis |first9=Vlassios |last10=Peitsidis |first10=Panagiotis |last11=Iatrakis |first11=George |last12=Nikolettos |first12=Nikolaos |date=2024-05-30 |title=Shoulder Dystocia: A Comprehensive Literature Review on Diagnosis, Prevention, Complications, Prognosis, and Management |journal=Journal of Personalized Medicine |language=en |volume=14 |issue=6 |pages=586 |doi=10.3390/jpm14060586 |doi-access=free |issn=2075-4426 |pmc=11204412 |pmid=38929807}}</ref>
Due to the anatomy of the clavicle, 80% of fractures occur in the middle third of its length which is its weakest point.<ref name=":3" /> When a clavicle fracture occurs, the sternocleidomastoid tends to pull the proximal (near trunk) portion of the clavicle upwards toward the head while the conoid and trapezoid ligaments, pectoralis minor muscle, and overall weight of the arm pull the distal (near shoulder) portion of the clavicle downwards, away from the head. This creates the typical "S" shaped deformity most often seen with clavicle injuries.
== Anatomy == thumb|Right clavicle bone with the right side of the skeleton fading in and out The clavicle serves as a strut and the only bony attachment between the trunk of the body (axial skeleton) and the bones of arm which are otherwise connected to the trunk through a series of muscles and ligaments.<ref name=":3" /> A clavicle is located on each side of the front, upper part of the chest and it is located directly above the first rib. The clavicle consists of a medial end, a shaft, and a lateral end. The medial end connects with the manubrium of the sternum and gives attachments to the fibrous capsule of the sternoclavicular joint, articular disc, and interclavicular ligament. The lateral end connects at the acromion of the scapula which is referred to as the acromioclavicular joint. The clavicle forms a slight S-shaped curve where it curves from the sternal end laterally and anteriorly for near half its length, then forming a posterior curve to the acromion of the scapula.<ref name=":2" /><ref name=":3" /> The clavicle widens and flattens at both ends while taking a hollow tubular shape through its middle segment with limited medullary bone resulting in a relative weak point where most fractures occur.<ref name=":2" /><ref name=":3" />
==Diagnosis== If a clavicle fracture is suspected, the initial method to evaluate for a clavicle fracture is by an AP (anterioposterior; horizontal through the body from front to back) or PA (posterioanterior; horizontal through the body from back to front) X-ray of the affected clavicle to determine the fracture type and extent of injury.<ref name=":2" /><ref name=":3" /> When an AP or PA view of the clavicle is taken, the xray beam is horizontal versus the body and the first rib and other structures overlap the clavicle which can make it more difficult to assess the clavicle, to avoid the overlap of other structures an xray of the clavicle can be obtained with a 20-30 degree cephalad (toward the head) to isolate the clavicle.<ref name=":2" /><ref name=":3" /> Although the degree of shortening of the clavicle can be often be assessed from the AP or PA dedicated clavicle images, additional AP or PA views of the chest can be taken to compare both clavicles for length or evaluate for other injuries that may be present such as rib fractures.<ref name=":2" /><ref name=":3" /> In cases where the physician suspects the fracture may involve the joint surfaces of the clavicle, to differentiate an epiphyseal injury from a sternoclavicular (SC) joint dislocation, or to evaluate injury to underlying neurovascular structures they may order a computerized tomography (CT) scan.<ref name=":2" /><ref name=":3" /> Diagnosis through ultrasound imaging performed in the emergency room may be utilized in children.<ref>{{cite journal | vauthors = Cross KP, Warkentine FH, Kim IK, Gracely E, Paul RI | title = Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department | journal = Academic Emergency Medicine | volume = 17 | issue = 7 | pages = 687–93 | date = July 2010 | pmid = 20653581 | doi = 10.1111/j.1553-2712.2010.00788.x | doi-access = free }}</ref>
== Classification == A clavicle fracture can be classified and described based on its location, displacement, angulation, pattern, and comminution. The most common classification system for these fractures is the Allman classification system which broadly divides these fractures based upon their location along the clavicle divided into thirds along its length.<ref name=":2" /><ref name=":3" />
=== Allman Classification ===
==== Group I ==== Fractures of the middle third of the clavicle. The most common type of clavicle fracture (80%) which both ends of the clavicle stablized and secured by muscular and ligamentous attachments.<ref name=":2" />
==== Group II ==== Fractures of the distal third (closest to shoulder) of the clavicle. Second most common type of clavicle fracture (15%). Can be further subdivided based upon fracture relative location to coracoclavicular ligaments as this can inform the presence of involvement of the acromioclavicular joint surface, ligamentous involvement, and fracture stability.<ref name=":2" />
==== Group III ==== Fractures of the proximal third (closest to neck/trunk) of the clavicle. These fractures need to be assessed for epiphyseal (growth plate) injury in pediatric patients. These fractures can be further subdivided based on displacement of the fracture, articular (joint) surface involvement, epiphyseal involvement, and comminution.<ref name=":2" />
==Treatment== The treatment of clavicle fractures depends on the type of fracture (Group I,II, or III) based upon which third of the clavicle length is affected, the degree of fracture displacement (distance fragments have moved out of their normal alignment), patient goals (speed of return to activity and activity level), and the presence of complications (open fracture, neurovascular compromise).<ref name=":3" /> Based upon these factors, clavicle fractures may be treated nonoperatively with immobilization and activity limitation or operatively. Medication may be prescribed for pain.<ref name=":1" /><ref name=":2" /> It is unclear if surgery or conservative management is superior.<ref name=Coch2019>{{cite journal |last1=Lenza |first1=Mário |author-link2=Rachelle Buchbinder|last2=Buchbinder |first2=Rachelle |last3=Johnston |first3=Renea V |last4=Ferrari |first4=Bruno AS |last5=Faloppa |first5=Flávio |title=Surgical versus conservative interventions for treating fractures of the middle third of the clavicle |journal=Cochrane Database of Systematic Reviews |date=22 January 2019 |volume=2019 |issue=1 |article-number=CD009363 |pmid=30666620|doi=10.1002/14651858.CD009363.pub3|pmc=6373576 }}</ref><ref name=":0">{{Cite journal |last1=Thurston |first1=Daniel |last2=Jordan |first2=Robert W. |last3=Thangarajah |first3=Tanujan |last4=Haque |first4=Aziz |last5=Woodmass |first5=Jarret |last6=D'Alessandro |first6=Peter |last7=Malik |first7=Shahbaz S. |date=2024-08-01 |title=Are displaced distal clavicle fractures associated with inferior clinical outcomes following nonoperative management? A systematic review |url=https://www.jshoulderelbow.org/article/S1058-2746(24)00057-0/abstract |journal=Journal of Shoulder and Elbow Surgery |language=English |volume=33 |issue=8 |pages=1847–1857 |doi=10.1016/j.jse.2023.12.006 |issn=1058-2746 |pmid=38281678|url-access=subscription }}</ref> Antibiotics and tetanus vaccination may be used if the bone breaks through the skin; however, this is uncommon.<ref name="Zlowodzki">{{cite journal | vauthors = Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD | title = Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group | journal = Journal of Orthopaedic Trauma | volume = 19 | issue = 7 | pages = 504–7 | date = August 2005 | pmid = 16056089 | doi=10.1097/01.bot.0000172287.44278.ef| s2cid = 41975051 }}</ref>
===Nonoperative=== Current practice for simple fractures without great displacement is generally to provide a sling, and pain relief, and to allow the bone to heal itself, monitoring progress with X-rays every week or few weeks if necessary. Surgery is employed in 5–10% of cases. However, a meta-analysis of 2 144 midshaft clavicle fractures supports primary plate fixation of completely displaced midshaft clavicular fractures in active adult patients.<ref name="Zlowodzki"/>
The arm is usually supported by an external immobilizer to keep the fracture stable and decrease the risk of further damage and pain.<ref name=":2" /><ref name=":3" /> The two most common types of fixation are the figure-of-eight splint that wraps the shoulders to keep them forced back and a simple broad arm sling (which supports the weight of the arm). The primary indication is pain relief. Type of sling used does not seem to affect the results as far as healing is concerned but patient satisfaction is lower with the figure-of-eight bandage due to discomfort and skin irritation. No difference in functional outcome has been reported between the two types of immobilization.<ref>{{cite journal | vauthors = Lenza M, Faloppa F | title = Conservative interventions for treating middle third clavicle fractures in adolescents and adults | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | article-number = CD007121 | date = December 2016 | issue = 12 | pmid = 27977849 | pmc = 6463869 | doi = 10.1002/14651858.CD007121.pub4 }}</ref> There is a lack of consensus on nonoperative vs operative treatment for minimally displaced middle third clavicle fractures with operative treatment possibly leading to lower rates of nonunion and residual deformity but potentially leading to the need for future hardware removal.<ref name=":1" /><ref name=":3" /> If the fracture is at the lateral end, the risk of nonunion is greater than if the fracture is of the shaft.<ref name="pmid19181992">{{cite journal | vauthors = Khan LA, Bradnock TJ, Scott C, Robinson CM | s2cid = 39095274 | title = Fractures of the clavicle | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 91 | issue = 2 | pages = 447–60 | date = February 2009 | pmid = 19181992 | doi = 10.2106/JBJS.H.00034 }}</ref> However, it seems that this does not affect the functional outcomes in most patients, indicated by recent systematic reviews.<ref>{{Cite journal |last1=Uittenbogaard |first1=Sophie J. |last2=van Es |first2=Laurian J.M. |last3=den Haan |first3=Chantal |last4=van Deurzen |first4=Derek F.P. |last5=van den Bekerom |first5=Michel P.J. |date=2023-02-01 |title=Outcomes, Union Rate, and Complications After Operative and Nonoperative Treatments of Neer Type II Distal Clavicle Fractures: A Systematic Review and Meta-analysis of 2284 Patients |journal=The American Journal of Sports Medicine |language=EN |volume=51 |issue=2 |pages=534–544 |doi=10.1177/03635465211053336 |pmid=34779668 |issn=0363-5465|hdl=1871.1/e325b6eb-66e4-4ab2-9e22-6306151fc36d |hdl-access=free }}</ref><ref name=":0" />
===Surgical=== [[File:ClaviclePlatePostFrac.jpg|thumb|Intra-operative image of clavicle fracture aligned and stabilized by a metal plate held in place by 6 screws. A Weitlaner retractor can also be seen]] In children, breaks in the middle of the clavicle treated with surgery resulted in faster recoveries but more complications.<ref>{{cite journal |last1=Gao |first1=B |last2=Dwivedi |first2=S |last3=Patel |first3=S |last4=Nwizu |first4=C |last5=Cruz AI |first5=Jr |title=Operative Vs. Non-operative Management of Displaced Midshaft Clavicle Fractures in Pediatric and Adolescent Patients: A Systematic Review and Meta-Analysis. |journal=Journal of Orthopaedic Trauma |date=15 July 2019 |doi=10.1097/BOT.0000000000001580 |pmid=31343597}}</ref> The evidence for different types of surgery for breaks of the middle part of the clavicle is poor as of 2023.<ref name=":1" /><ref name=":3" /><ref name="Coch2019" /><ref>{{cite journal | vauthors = Lenza M, Faloppa F | title = Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 5 | article-number = CD007428 | date = May 2015 | pmid = 25950424 | doi = 10.1002/14651858.CD007428.pub3 | doi-access = free | pmc = 11162556 }}</ref>
Surgery may be considered when one or more of the following is presents * Comminution with separation (bone is broken into multiple pieces) * Skin penetration (open fracture) * Associated nervous and vascular trauma (brachial plexus or supraclavicular nerves) * Nonunion after several months (3–6 months, typically) * Displaced distal third fractures (high risk of nonunion) * Although shortening (as a result of overlap of fracture ends) has often been suggested as an indication for surgery, a review found that people treated without surgery for shortening of mid shaft clavicle fractures did not affect outcomes.<ref>{{Cite journal|last1=Malik|first1=Shahbaz S.|last2=Tahir|first2=Muaaz|last3=Jordan|first3=Robert W.|last4=Malik|first4=Sheraz S.|last5=Saithna|first5=Adnan|date=August 2019|title=Is shortening of displaced midshaft clavicle fractures associated with inferior clinical outcomes following nonoperative management? A systematic review|journal=Journal of Shoulder and Elbow Surgery|volume=28|issue=8|pages=1626–1638|doi=10.1016/j.jse.2018.12.017|pmid=30929954|url=http://irep.ntu.ac.uk/id/eprint/35835/1/13384_Saithna.pdf}}</ref>
A discontinuity in the bone shape often results from a clavicular fracture, visible through the skin, if not treated with surgery due to imperfect bone alignment or bony callous formation during fracture healing. Surgical procedures often call for [[ORIF|open reduction internal [plate] fixation]] where an anatomically shaped titanium or steel plate is affixed along the superior or anterior aspect of the bone by several screws. In some cases, the plate is removed after healing due to discomfort, to avoid tissue aggravation, osteolysis or subacromial impingement. This is especially important with a special type of fixation plate used in distal third fractures called a hook plate.<ref>{{cite journal | vauthors = Tiren D, van Bemmel AJ, Swank DJ, van der Linden FM | title = Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview | journal = Journal of Orthopaedic Surgery and Research | volume = 7 | page = 2 | date = January 2012 | pmid = 22236647 | pmc = 3313877 | doi = 10.1186/1749-799X-7-2 | doi-access = free }}</ref> With anatomical plates, plate removal is considered an elective procedure that is rarely necessary. An alternative to plate fixation is elastic TEN intramedullary nailing. These devices are implanted within the clavicle's canal to support the bone from the inside. Typical surgical complications are infection, loss of sensation below the incision on the chest due to inadvertent injury of one or several supraclavicular nerves (most common when using a horizontal surgical incision),<ref>{{Cite journal |last1=Chechik |first1=Ofir |last2=Batash |first2=Ron |last3=Goldstein |first3=Yariv |last4=Snir |first4=Nimrod |last5=Amar |first5=Eyal |last6=Drexler |first6=Michael |last7=Maman |first7=Eran |last8=Dolkart |first8=Oleg |date=2019-08-01 |title=Surgical approach for open reduction and internal fixation of clavicle fractures: a comparison of vertical and horizontal incisions |journal=International Orthopaedics |language=en |volume=43 |issue=8 |pages=1977–1982 |doi=10.1007/s00264-018-4139-9 |pmid=30187099 |issn=1432-5195}}</ref> and nonunion of the bone (failure of the bone to properly fuse together). The risk of injury to the supraclavicular nerves can be reduced by using a minimally invasive approach to the clavicle for middle third fractures.<ref>{{Cite book|edition=Sixth|title=Surgical exposures in orthopaedics: the anatomic approach|publisher=Wolters Kluwer|date=2022|location=Philadelphia|isbn=978-1-9751-6879-7|first1=Piet G.|last1=De Boer|first2=Richard|last2=Buckley|first3=Stanley|last3=Hoppenfeld|first4=Stanley|last4=Hoppenfeld|pages=6}}</ref> Major nerve injury to the brachial plexus or vascular injury is extremely rare.<ref>{{Cite journal |last1=Wijdicks |first1=Frans-Jasper G. |last2=Van der Meijden |first2=Olivier A. J. |last3=Millett |first3=Peter J. |last4=Verleisdonk |first4=Egbert J. M. M. |last5=Houwert |first5=R. Marijn |date=2012-05-01 |title=Systematic review of the complications of plate fixation of clavicle fractures |journal=Archives of Orthopaedic and Trauma Surgery |language=en |volume=132 |issue=5 |pages=617–625 |doi=10.1007/s00402-011-1456-5 |issn=1434-3916 |pmc=3332382 |pmid=22237694}}</ref>
==Prognosis==
Healing time varies based on age, health, fracture complexity, location of the break, fracture displacement, treatment course (operative vs nonoperative), and the presence/number of complications.<ref name=":1" /><ref name=":2" /><ref name=":3" />
For adults undergoing nonoperative treatment, one to several weeks of sling immobilization is normally employed to allow for pain relief, initial bone and soft tissue healing; teenagers require slightly less, while children can often achieve the same level in two weeks. During this period, patients may remove the sling to practice passive pendulum range of motion exercises to reduce atrophy in the elbow and shoulder, but they are often minimized to 15–20° off vertical. Depending on the severity of fracture, a person can begin to use the arm if comfortable with movement and no pain results. The final goal is to be able to have full range of motion with no pain; therefore, if any pain occurs, allowing for more recovery time is best. Depending on severity of the fracture, athletes involved in contact sports may need a longer period of rest to heal to avoid re-fracturing the clavicle due to the higher demand placed on this bone. '''Full bone strength can take several months to years after fracture''', with most studies showing substantial recovery by 3-6 months but complete restoration of strength often requiring 1-2 years or longer.<ref>{{Cite journal|title=The biology of fracture healing|journal=Injury|date=June 2011|pmc=3105171|pmid=21489527|pages=551–555|volume=42|issue=6|doi=10.1016/j.injury.2011.03.031|language=en|first1=Richard|last1=Marsell|first2=Thomas A.|last2=Einhorn}}</ref>
For patients undergoing operative treatment, functional recovery and return to work often occurs early than those undergoing nonoperative treatment for the similar fractures although long-term results show no significant difference.<ref name=":1" /><ref name=":3" /> Complication rates are relatively low but include infection (0.6-3.2% deep infections), hardware irritation requiring removal (approximately 10%), and wound-related issues.<ref name=":1" /><ref name=":2" />
==Epidemiology== Clavicle fractures occur at 30–64 cases per 100,000 a year and are responsible for 2.6–5.0% of all fractures and 44-66% of fractures around the shoulder.<ref name=":1" /><ref name=":2" /><ref name=":3" /><ref name="Malik2010">{{cite journal | vauthors = Malik S, Chiampas G, Leonard H | title = Emergent evaluation of injuries to the shoulder, clavicle, and humerus | journal = Emergency Medicine Clinics of North America | volume = 28 | issue = 4 | pages = 739–63 | date = November 2010 | pmid = 20971390 | doi = 10.1016/j.emc.2010.06.006 }}</ref> Fractures of the middle third of the clavicle are the most common and make up 80% of all clavicle fractures.<ref name=":1" /><ref name=":2" /><ref name=":3" /> Lateral third (closest to shoulder) and medial third (closest to trunk) fractures consist of 15% and 5% of clavicle fractures respectively. This type of fracture occurs more often in males.<ref name="Malik2010"/> Clavicle fractures involve roughly 5% of all fractures seen in hospital emergency admissions. Clavicles are the most commonly broken bone in the human body.<ref>{{cite book | first = Richard S. | last = Snell | name-list-style = vanc | title=Clinical Anatomy by Regions | edition=8th | publisher=Lippincott Williams & Wilkins |date=2010-03-10 | page=433 |chapter=Chapter 9: The upper Limb | isbn=978-0-7817-6404-9}}</ref>
==History== Hippocrates, 4th century BC: {{blockquote|When, then, a [clavicle] fracture has recently taken place, the patients attach much importance to it, as supposing the mischief greater than it really is, and the physicians bestow great pains in order that it may be properly bandaged; but in a little time the patients, having no pain, nor finding any impediment to their walking or eating, become negligent; and the physicians finding they cannot make the parts look well, take themselves off, and are not sorry at the neglect of the patient, and in the meantime the callus is quickly formed.<ref>{{cite web|title=The Internet Classics Archive {{!}} On the Articulations by Hippocrates|url=http://classics.mit.edu/Hippocrates/artic.14.14.html|website=classics.mit.edu|access-date=26 October 2017|url-status=live|archive-url=https://web.archive.org/web/20170226025453/http://classics.mit.edu/Hippocrates/artic.14.14.html|archive-date=26 February 2017}}</ref>}}
From an ancient Egyptian text of approximately the 30th century B.C., in a copy known as the Edwin Smith papyrus, J. Breasted translation, case 35: {{blockquote|If thou examinest a man having a break in his collar bone and shouldst thou find his collar bone short and separated from its fellow, thou shouldst say concerning him: "One having a break in his collar-bone. An ailment which I will treat." Place him prostrate on his back with something folded between his shoulder blades; thou shouldst spread out with his two shoulders to stretch apart his collar bone until the break falls in its place.<ref>{{cite web | first = G. Zaki | last = Said | name-list-style = vanc | url =http://www.aofoundation.org/portal/AOFileServer/PortalFiles?FilePath=%2FExtranet%2FActive%2F_att%2Fwor%2Fact%2FDialogue%2F2002_1%2Fancient_egypt.pdf | title = The management of skeletal injuries in ancient Egypt |date=28 September 2007|url-status=bot: unknown|archive-url=https://web.archive.org/web/20070928091839/http://www.aofoundation.org/portal/AOFileServer/PortalFiles?FilePath=%2FExtranet%2FActive%2F_att%2Fwor%2Fact%2FDialogue%2F2002_1%2Fancient_egypt.pdf | archive-date= 28 September 2007 }}</ref><ref name=breasted>{{cite book |title=The Edwin Smith surgical papyrus, published in facsimile and hieroglyphic transliteration with translation and commentary in two volumes |date=1930 |publisher=University of Chicago, Oriental Institute |location=Chicago, Ill. |isbn=978-0-918986-73-3|url=https://oi.uchicago.edu/sites/oi.uchicago.edu/files/uploads/shared/docs/oip3.pdf|pages=350–354|first1=J. H.|last1=Breasted}}, fulltext of translation with commentary. (capitalization altered and interleaved glosses removed in quote)</ref>}}
All the cases in this text describe examination, prognosis, and (where applicable) treatment, in that order.<ref name=breasted/>
== References == {{Reflist}}
== External links == * [http://orthoinfo.aaos.org/topic.cfm?topic=a00072 Details from AAOS] {{Medical resources | ICD10 = {{ICD10|S|42|0|s|40}} | ICD9 = {{ICD9|810}} | ICDO = | OMIM = | MedlinePlus = 001588 | eMedicineSubj = orthoped | eMedicineTopic = 50 | DiseasesDB = }}
{{Fractures}}
{{DEFAULTSORT:Clavicle Fracture}} Category:Bone fractures Category:Injuries of shoulder and upper arm Category:Wikipedia medicine articles ready to translate