Clavicle (Collarbone) Fracture

What is it?

The clavicle, or collar bone, is the bone that connects the shoulder to the chest. It doesn’t move much, but it is important to help "stabilize" the shoulder when a person throws or pushes something. Clavicle fractures are common in children. They can happen when a child falls or if someone or something falls onto a child. Clavicle fractures are also common in car accidents when the child was wearing a shoulder belt. This does NOT mean that the shoulder belt was bad. A clavicle injury is almost never serious compared with the other injuries that happen without a seat belt. Newborn babies sometimes have clavicle fractures as a result of a difficult delivery.

Pain and mobility are the biggest concerns in clavicle fractures. Broken bones hurt mostly when they move, so we try to limit their movement. Most clavicle fractures happen near the middle of the bone, and those fractures heal without complications. Fractures of the clavicle very near the shoulder are called "distal clavicle fractures." These fractures often do not heal properly even with the best of treatment. An improperly healed clavicle fracture may cause loss of movement or strength in the arm. Sometimes a child or teen with a distal clavicle fracture needs to have surgery to repair it. Your doctor will refer you to an orthopedic surgeon if s/he is concerned about a distal clavicle fracture.

We cannot put a clavicle in a cast or splint to reduce movement and pain, the way we would for most bones. That means we have to find other ways to keep the clavicle from moving and causing pain. The most common treatment is to brace the shoulder. Some doctors use a simple arm sling that keeps the arm close to the body. Other doctors use a "shoulder immobilizer" or "figure-8" bandage that holds the child’s shoulders back. Both of these treatments prevent the child from reaching, throwing, or doing other things that would hurt. Even without any brace or sling, most clavicle fractures will heal normally. The brace or sling is really just to keep the child comfortable. If your doctor gave you a sling, be sure to remove it when your child is sleeping to prevent your child from getting his or her neck tangled in it.

Give your child acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) as directed for the next 24 – 72 hours to help relieve any pain.  You may want to read our Aftercare Instruction on giving Oral Medications.

Most clavicle fractures are not very painful. The following are signs that the fracture is not healing properly or that some other injury may also be present:

• Pain that gets worse rather than better over time
• Pain that you cannot control with over-the-counter pain medications
•  Numbness, tingling, coolness, or paleness of the arm or hand
• Difficulty breathing
• Dizziness or light-headedness

If any of these occur, please be sure to call your doctor’s office right away.

Clavicle fractures are usually relatively minor injuries, and it is usually obvious how the injury occurred. Sometimes a clavicle fracture happens when a child or a teenager gets hit by another person. If your child seems fearful or will not talk about how the injury happened, or if you see other injuries such as bruises that the child cannot explain, please discuss this with your doctor.

Sometimes a clavicle fracture is the most obvious injury because it is so painful. It can be easy to overlook other more serious injuries. These other injuries are much more likely to be present in the case of a high-energy or high-speed accident, like a fall from a height or a car accident. A rib fracture may be present in some cases. Fractures of the first rib are very serious because they indicate a high-energy injury, and because large and important blood vessels and nerves run nearby. For the same reason, a dislocation of the part of the clavicle that connects to the breast bone (sternum) is very serious. X-rays of the clavicle very often will show a first rib injury. A dislocation of the clavicle and sternum requires special x-rays to see it.

Rarely, a child or teen with only a clavicle fracture will also have a more serious injury to a nerve or a blood vessel in the same area. People with those injuries usually have pain, numbness, tingling, or paleness of the arm or hand on the same side of their body.

In some children and especially teens, the ligament that connects the clavicle to the shoulder blade (the acromio-clavicular ligament) can be stretched or broken. This is sometimes called a "shoulder separation" or "A-C separation." Treatment for these injuries is similar to treatment for clavicle fractures. People with these injuries require careful follow-up to be sure that they do not need surgical repair later on.

In some cases, teenagers can have a shoulder dislocation.  This happens when the upper arm bone (the humerus) comes out of the shallow socket on the shoulder blade. Because a shoulder dislocation is very painful and often causes a visible bulge on the front of the shoulder, it can look like a clavicle fracture. An x-ray of the shoulder will tell the difference easily.

Having an injured child at home can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children who are injured are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.