Clavicle (collarbone) Fractures in Kids and Adolescents
- huntergreene35
- Aug 30, 2023
- 4 min read
Football season is upon us, so I thought I would start out with a common football related injury.......the clavicle fracture. The clavicle is also commonly referred to as the collarbone. I recently listened to a podcast discussing pediatric clavicle fractures. Pediatric Sports Medicine Podcast did a wonderful job of covering the subject. If you want to hear some sports medicine doctors talking in detail about how these injuries are treated and all the latest research, please check it out.
What Is the Clavicle?
The clavicle is a thin, slight s-curved bone that essentially attaches the shoulder complex to the center of the body. It runs from the top of the breastbone (sternum) out to the top part of the shoulder. It also serves as an attachment for a number of muscles.
How is it injured?
The most common way the collarbone is broken is by landing forcefully on the outside tip (lateral aspect) of the shoulder. If the force is great enough, the clavicle can break. This type of injury is commonly seen when football fall on the shoulder after being tackled or if the tackler's weight falls directly on the player being tackled. It is also seen in other collision sports such as hockey. Bicycle wrecks also result in a good number of clavicle fractures.
How Do You Know if Its Broken?
Unless you have x-ray vision, you will not know until you go see a doctor and get some x-rays, but your kid will probably give you a good idea because it is a very painful injury. If they fall on their shoulder in the way I described above, and they are in a lot of pain over the collarbone, it is probably a good idea to go get it evaluated. They will guard their shoulder from any movement, and you may be able to see an area of deformity on top of the collarbone. There may be a bump poking up just under the skin. If the bone is sticking out of the skin, that is obviously not good, and we need to get to the Emergency Room quickly. Any time a bone pokes through the skin, there is increased concern for infection, and trust me......you do not want that for your child.
If you are fortunate enough to have an Athletic Trainer around, they should be able to provide a sling and swathe for comfort on the way to get x-rays. If you do not have any supplies at your disposal, do you best to immobilize the shoulder if you can. The video below uses just an ace bandage to immobilize the shoulder.
Collarbone is broken......what's next?
Ok......the acute pain and shock of the injury has passed, and we know that the collarbone is broken. What are our treatment options? Generally speaking, your child will be in a sling for 4-6 weeks to let it heal. Below is a link to a non-affiliated sling to give you an idea of what the sling may look like.
Sports activities will not be allowed while the bone is healing, so the kid will need to be mentally prepared to sit out for a while. Once the bone is healed on x-rays, the pain is gone and the shoulder regains full strength, a return to play plan can be made with the help of your doctor, physical therapist and/or athletic trainer. If the child is returning to a non-contact sport, a discussion can be had about gradual return around the 6 weeks mark. Unfortunately for football players, you are looking at 2-3 months before a safe return due to the increased risk of breaking the bone again before the bone fully hardens. (Management of Clavicle Fractures : Current Sports Medicine Reports (lww.com)
A very low percentage of child and adolescent clavicle fracture actually need surgery due to increased ability to heal fractures at these younger ages. It does happen though and follow the advice of your doctor if your child fits into the parameters for surgery. I plan to cover surgery for collarbone fractures in a future blog post.
Common Reasons Parents 'Freak Out'......
It is very common for parents to see x-rays of their kid's broken collarbone and wonder how in the world is that thing going to heal? There are times when the two pieces of bone a broken and right next to each other, but there are times when the fracture is very displaced. That means the two ends are way far away from each other. Fractures generally heal better when the two bones ends are touching each other.
Clavicles in children have a very thick periosteum around them. The periosteum is kind of like a very thick rubber coating around the bone where the blood supply comes from. The periosteum provides the nutrients needed for the bone to heal even if the ends are very close to each other, so if your doctor tell you that the bone will heal even if it looks terrible, believe him or her. They generally do.
Will my baby be deformed forever? Healed clavicle fractures (especially ones that are displaced) generally leave a bump where the fracture was. The clavicle is just below the skin, and does not have much tissue covering it, so any abnormalities can be noticeable. The good news here is that the human body is an amazing thing especially when it comes to the healing potential of young people. My advice here is to just give it time. You will be amazed that over the course of the next year that bump will slowly get smaller (maybe not completely go away). Young people have an amazing ability to 'remodel' bone back to a relatively normal state.
In conclusion, collarbone injuries are scary from a kid and parent perspective, but rest assure that they are quite common and generally have very good outcomes.
Hunter Greene, MS, ATC, OPA-C
**Disclaimer: Please consult with a local healthcare professional for definitive diagnosis and treatment. This information should not be used to diagnose and treat injuries.
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