The collarbone – or clavicle – is located between the sternum and shoulder. If you fall or receive a heavy blow to the bone, you can fracture your collarbone. There are different types of clavicle fractures depending on which section of the bone breaks:
- Midshaft fractures occurs in the middle of the bone. This is the most common type of clavicle fracture, accounting for around 80% of such injuries.
- Distal fractures occur on the outside part of the collarbone, closest to the shoulder. These make up around 15% of collarbone fractures.
- Medial fractures, which occur in the section of bone closest to the sternum, are the least common of collarbone fractures accounting for just 5%.
In this article we will look at the symptoms, diagnosis and treatment of distal clavicle fractures (sometimes also called lateral clavicle fractures).
How do distal clavicle fractures happen?
Distal clavicle fractures are often caused by falling onto an outstretched hand or landing heavily on the shoulder. They may also occur as the result of a vehicle collision or a fall from a bike.
Symptoms of a distal clavicle fracture
The primary symptom is acute pain at the end of the collarbone closest to the shoulder. You may notice a lump at the top of the shoulder, which is caused by the bone becoming displaced, and the area may appear swollen and bruised. If you try to move your shoulder you may experience a clicking sensation.
Treating a distal clavicle fracture
If a broken collarbone is suspected, you will be given an X-ray and possibly also a CT scan to reveal which section of the bone is broken and whether any fragments of bone have become displaced. A comminuted fracture is where the bone has fractured into multiple pieces.
Treating a distal clavicle fracture will depend on whether or not the fracture is displaced. You may be offered conservative treatment or surgical treatment.
Conservative treatment:
If the broken sections of bone remain in alignment (referred to as an undisplaced distal clavicle fracture), the fracture will normally heal without surgery. We call this conservative treatment and it normally involves:
- Immobilisation using a sling or figure-of-eight brace. This keeps the area immobilised for four or five weeks while the bone heals. A programme of physiotherapy exercises is begun after 2-4 weeks, with gentle range of motion exercises. Strengthening exercises are introduced at 6-10 weeks. It can take several months before the fracture mends completely.
Surgical treatment:
If you have sustained a displaced distal clavicle fracture, surgery is normally needed as there is a high risk that the fracture will not heal correctly (referred to as non-union). Surgery for a displaced fracture involves realigning the bones so they are in the correct position and then holding them in place. There are different surgical procedures depending on the type and extent of the fracture. For example:
- Open reduction internal fixation – An incision is made below the collarbone close to the shoulder. The bone fragments are put back into position and fixed in place with a plate and screws. The coracoid process is a bony projection from the shoulder blade to which muscles and ligaments are attached. It helps to stabilise the shoulder joint. Special sutures are used around the coracoid process and the plate holding the fragments of bone in place. These help to prevent the shoulder muscles from pulling the fragments out of alignment. While the surgical repair is generally very successful, for some patients, the plate causes irritation beneath the skin and has to be removed. For this reason, some surgical repairs use figure-of-eight sutures and no plate. However, this is only possible in certain circumstances, for example if the fracture is small.
- Other surgical options include using AC joint spanning fixation, transacromial fixation, tension band wires, coracoclavicular ligament repair/reconstruction and a modified Weaver-Dunn procedure which is mainly used for AC dislocations.
Treating a distal clavicle fracture is a complex process that requires considerable skill to avoid the risk of incorrect healing. For advice about the different treatment options and effective rehabilitation, please contact us.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
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