Shoulder

Clavicle Fracture

Clavicle (collarbone) fractures are among the most common fractures in all age groups, frequently resulting from sports collisions, cycling falls, and direct shoulder impacts. While most heal predictably with a sling alone, certain fracture patterns — significant displacement, shortening, or lateral third involvement — carry a higher risk of malunion or nonunion and may warrant surgical fixation. At Maryland Orthopedic Specialists, we provide individualized assessment and evidence-based care for the full spectrum of clavicle fractures, helping you achieve the best possible healing with the fastest return to activity.

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What is clavicle fracture?

The clavicle is the S-shaped bone connecting the sternum to the acromion of the shoulder blade. It serves as the only bony strut linking the upper extremity to the axial skeleton and provides attachment for critical muscles (trapezius, deltoid, pectoralis major) and the coracoclavicular ligaments.

Location and Frequency

Clavicle fractures are divided anatomically by thirds:

Middle third (diaphysis): The most common location, accounting for approximately 80% of all clavicle fractures. The clavicle is thinnest here and has no muscular attachments to prevent displacement.
Lateral third (distal clavicle): Approximately 15% of fractures; carries higher nonunion risk (discussed below).
Medial third (proximal clavicle): Rare (~5%); associated with high-energy mechanisms; proximity to great vessels and the brachial plexus warrants careful evaluation.

Displacement and Shortening: Key Prognostic Factors

In middle-third fractures, the deforming forces are predictable: the sternocleidomastoid pulls the proximal fragment superiorly and medially, while the weight of the arm displaces the distal fragment inferiorly. The resulting displacement and shortening are the primary clinical variables that influence surgical decision-making:

Shortening ≥ 2 cm is a strong operative indication; multiple studies associate shortening with higher nonunion rates and inferior shoulder strength and function with non-operative treatment
Complete displacement (no cortical contact) significantly reduces the union surface area and contributes to malunion risk
Skin tenting (risk of open fracture) is a relative urgency for fixation

Treatment options

Non-Operative Management (Sling)

The majority of middle-third clavicle fractures are managed with a simple sling for 4–6 weeks. Despite initial displacement, the union rate with non-operative management remains high (~90% for non-displaced/minimally displaced fractures). Figure-of-eight bandages offer no advantage over a simple sling and are less comfortable.

Operative Fixation (ORIF with Plate and Screws)

Open reduction and internal fixation (ORIF) using a low-profile locking or precontoured plate is the standard surgical technique. Plating restores clavicle length, corrects malrotation, and provides immediate rigid fixation allowing early shoulder mobilization.

Lateral Third (Distal Clavicle) Fractures

Lateral third fractures warrant special consideration because nonunion risk is substantially higher (15–30% with non-operative management). This is attributed to the fracture occurring distal to the coracoclavicular ligaments, which allow the proximal fragment to displace superiorly while the CC ligaments hold the distal fragment down.

Frequently Asked Questions

Do I need surgery for my broken collarbone?

Most middle-third fractures with limited displacement heal well in a sling. However, significant shortening (≥ 2 cm) or complete displacement in an active person may be better served by surgical fixation. We will review your specific X-ray findings and activity level to guide the decision.

How will I know if my fracture isn't healing?

Persistent pain, motion at the fracture site beyond 3 months, and absence of callus on X-ray are signs of nonunion. We monitor healing at regular intervals; if nonunion develops, surgery with bone grafting is highly effective.

Will the plate need to be removed?

Most patients keep the plate permanently with no issues. Plate removal is performed electively if there is irritation under the skin or hardware prominence, typically after 12–18 months.

How long does it take for a broken collarbone to heal?

Most clavicle fractures in adults heal within six to twelve weeks. Non-surgically treated fractures are typically immobilized in a sling for four to six weeks, followed by progressive physical therapy. Surgically fixed fractures often allow earlier return of shoulder motion, with most patients regaining full function by three to four months. Healing time can be longer in smokers, patients with osteoporosis, or those with a widely displaced fracture. Your MOS surgeon will monitor healing with X-rays and adjust your rehabilitation accordingly.

What are the long-term risks of a clavicle fracture that heals in a non-ideal position (malunion)?

If a clavicle heals with significant shortening or angulation, some patients experience persistent shoulder weakness, asymmetry, or pain with overhead activity or heavy lifting. In most cases the functional impact is mild and does not require further treatment. However, severely shortened clavicles can cause impingement of the brachial plexus or subclavian vessels, and these cases may benefit from corrective osteotomy. At MOS we monitor healing closely and discuss functional outcomes with you, so any concerns about malunion can be addressed promptly.