Three bones make up the shoulder girdle – the humerus (or arm bone), the scapula (or shoulder blade), and the clavicle (or collar bone). The upper part of the humerus attaches to a socket on the side of the shoulder blade (called the glenoid) and forms the shoulder joint, known as the “glenohumeral joint.” Above the glenohumeral joint and on the top part of the shoulder, the clavicle attaches to another part of the scapula called the acromion at a smaller joint called the acromio-clavicular (AC) joint. The clavicle forms a strut that connects the central or “axial” skeleton (rib cage and spine) to the shoulder girdle and helps maintain the length and contour of the shoulder.
Clavicle fractures are common injuries that usually result from a fall on the shoulder (such as falling off a bike) or direct impact onto the top of the shoulder. These injuries vary in severity in terms of their displacement (or separation of bone ends), shortening of the clavicle, and whether the fracture is in several pieces.
Pain on top of the shoulder, in the area of the clavicle, is the most common symptom of a clavicle fracture. There may be associated swelling and bruising in the area of injury. With severe injuries, there may be an obvious deformity, such as the ends of the broken clavicle sticking up and becoming prominent under the skin.
The diagnosis of clavicle fractures is usually made by a history of the patient’s injury and from a physical examination. X-rays confirm the diagnosis and help to grade the severity of the injury.
Treatment of clavicle fractures depends on the severity of the injuries. Most low-grade injuries are successfully treated with a period of rest and use of a sling, icing, and pain medications as needed. Most of these injuries heal within 4-8 weeks. More severe injuries may have delayed or limited ability to heal. In addition, recent research has shown that fractures with significant displacement, shortening of the bone, or those with multiple fracture pieces are best treated with surgery. Patients with severe injuries show better functional outcome and higher satisfaction after surgical treatment.
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