The collar bone, or clavicle, is located across the upper part of the chest, extending from the breast bone (sternum) to the shoulder blade (scapula). It is easy to feel the clavicle as there are no overlying muscles, just skin.
The clavicle is a common site to fracture, especially in the middle third of the bone. These injuries are common in children, adolescents and athletes and can also occur in babies as a result of birthing trauma.
The most common causes are:
• A fall onto an outstretched hand.
• A fall onto the shoulder.
• A direct blow to the clavicle.
After the clavicle is fractured, the sternocleidomastoid elevates the proximal fragment of the bone. The trapezius muscles are unable to hold up the distal fragment, owing to the weight of the upper limb, and thus the shoulder droops. The adductor muscles of the arm, such as the pectoralis major, may pull the distal fragment medially, causing the bone fragments to override.
The symptoms of a clavicle fracture are pain, swelling, bruising and disability with an inability to move the fractured arm. After the swelling has subsided, the fracture can often be felt through the skin.
SHOULDER PAIN: COLLAR BONE FRACTURE TREATMENT
In the majority of cases, clavicular fractures are treated non-surgically with painkillers and by immobilising the arm in a sling, thus giving the injured bone time to heal and reunite. Follow up x-rays will then be performed to visualise union progression.
If the fracture results in the skin being penetrated, neurovascular injury, multiple fracture fragments or if the fracture fragments have not reunited, surgery will be the method of choice for treatment. A steel or titanium plate will then be utilised to stabilise the fracture site (Open Reduction Internal Plate Fixation).