By Jonathan Cluett, MD 

 Medically reviewed by Oluseun Olufade, MD

 Fact checked by Zerah Isaacs

Clavicle fractures, or broken collarbones, are typically treated without surgery. There is some evidence, though, to suggest that clavicle fractures may heal faster and more predictably when surgical repair is done.

There are reasons for either treatment approach. Most fractures of the clavicle heal well with rest and a sling, but specific features about the break—and your overall health—may mean surgery is warranted.1

This article explains the rationale behind a decision to treat clavicle fractures with surgery, as well as when it should be avoided. It will help you to better understand the benefits and risks of your treatment options.

Clavicle Fractures

A collarbone fracture is a common injury and represents up to 4% of all broken bones, especially among younger, more active adults.2

The clavicle is the bone in the front of the chest on top of the rib cage. It helps to support normal shoulder function and is the attachment point for several important muscles, including the deltoid and pectoralis muscles.

People sustain clavicle fractures from a variety of injuries, including:

• Falls

• Automobile accidents

• Sports injuries

• Other traumatic injuries

These injuries typically lead to different types of clavicle fracture. Sports injuries, for example, usually affect the middle and outer part of the bone, which account for 95% of all cases. The inner part of the bone, near the sternum (breastbone) is usually broken with direct force.3

When a clavicle fracture occurs, it is common to have pain and swelling at the site of the injury. People can often see a deformity of the bone, especially soon after the injury before swelling has worsened.

Over time, bruising may show up around the fracture site and even into the chest and arm. People with a clavicle fracture have a hard time using their arms because the movement causes pain at the site of the fracture.

Your healthcare provider will X-ray the clavicle to determine if a fracture is present and to determine the most appropriate treatment. Additional tests such as computed tomography (CT) scans or magnetic resonance imaging (MRI) are seldom needed to identify a fracture or determine treatment recommendations.

 Douglas Sacha / Getty Images

When Not to Have Surgery

Most clavicle fractures can be treated without surgery. For the vast majority of clavicle fractures that are not out of place, or only minimally out of place, the safest and most effective treatment is with the use of a sling or special bandage splint to keep it immobilized.1

Surgery is invasive and may lead to complications. Further, surgery to repair a clavicle fracture may require a second surgery later on to remove the hardware used to repair the break.

There are steps you can take to speed your healing, but managing these injuries with nonsurgical treatment is often the best course of action.

Surgery can have its advantages, but there are also risks of surgery that should not be ignored. A complication of surgery can be worse than the original injury, and while these complications may be uncommon, there might not be a reason to take the risk.4

When to Have Surgery

Most orthopedists (bone specialists) agree that when there is a badly displaced fracture of the clavicle, surgical treatment should be considered. Some factors that may be considered include if the fracture is in the dominant arm or the likelihood of nonunion of the fracture (lack of healing).

When there is displacement or malalignment of the broken bone, surgery may be considered to prevent problems with the healing of the fracture. Studies have found that the risk of nonunion is high when the fracture is poorly aligned.5

If this occurs, or if there is a concern about loss of function, surgery may be a reasonable treatment. Specific risks for nonunion of a fracture include:

• Being a biological female6

• Older age6

• Displacement of the fracture (broken ends not touching)

• Comminution (multiple, small fragments of bone)

• Smoking status6

Size and Shape of the Clavicle Fracture

Surgery should be strongly considered if the fracture is shortened by 2 centimeters or more, or is displaced by more than 100% (the fractured ends aren't touching at all). It's also true when there are specific fracture patterns (such as Z-type fractures), or when the fractures are highly comminuted (shattered).7

Surgery may improve healing in these specific cases. It was once thought that injuries undergoing nonsurgical treatment had a higher chance of healing. Experts now believe that surgery will lead to more predictable healing with a lower chance of nonunion.8

Complications

When contemplating surgery, the possible disadvantages also need to be considered. There are still many risks of surgery, with a 2022 British study of 21,340 cases concluding that complications occur in 8.1% of people who have surgery for a clavicle fracture.2

Painful Hardware

By far the most common problem with surgery is that many people are bothered by the hardware used to repair their broken clavicle. Most often, a plate and screws are placed along the bone to hold it in position, and these can typically be felt under the skin.

A person is likely to feel annoyed by the hardware as they feel it under a bra strap, backpack strap, or seatbelt chest strap. Many people will choose to have the hardware removed after the break has healed, which is usually at least six months after their initial surgery and most commonly about a year after surgery.7

Infection

Infection of hardware can cause significant problems. Because the metal hardware is close to the skin, the chance of infection is not insignificant. The same 2022 British study found 3.5% of people who have clavicle fracture surgery develop an infection from their surgery.2

Nerve Injury

Major nerve damage is very uncommon, but the skin nerves that provide sensation just below the collarbone are often damaged at the time of surgery.9

Many people who have clavicle fracture surgery notice a patch of numbness or tingling just under their incision. Over time, it may become smaller and less noticeable, but it tends to persist.

An Increased Risk for Complications

Complications of surgery are more common in people who have other medical conditions such as diabetes, smokers, and those with other chronic medical conditions. In these people, risks of complications may outweigh the benefits of surgery, even in situations where the fracture is badly displaced.

Summary

Clavicle fractures are common injuries and will often heal without surgery. However, orthopedic surgeons are recommending surgery more commonly as a means to provide more predictable healing timelines and recovery of function.

When a fracture is displaced (the ends of the broken bone are not touching) and there is a higher risk of nonunion, surgery can lead to more reliable healing of the fracture.7 While surgery has advantages in these situations, there are also risks of clavicle fracture surgery that should be considered.

Your orthopedic surgeon can help you decide the most appropriate treatment for your fractured collarbone.

Sources

Johns Hopkins Medicine. Clavicle Fractures.

Wolf S, Chitnis AS, Manoranjith A, Vanderkarr M, Plaza JQ, Gador LV, et al. Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England. BMC Musculoskelet Disord. 2022 Feb 9;23(1):135. doi:10.1186/s12891-022-05075-5. 

Harvard Health Publishing. Collarbone (Clavicle) Fracture.

Clitherow HD, Bain GI. Major neurovascular complications of clavicle fracture surgery. Shoulder & Elbow. 2015;7(1):3-12. doi:10.1177/1758573214546058

Wildemann B, Ignatius A, Leung F, et al. Non-union bone fractures. Nat Rev Dis Primers. 2021;7(1):57. doi:10.1038/s41572-021-00289-8

Mills LA, Aitken SA, Simpson AHRW. The risk of non-union per fracture: Current myths and revised figures from a population of over 4 million adults. Acta Orthop. 2017;88(4):434-439. doi:10.1080/17453674.2017.1321351

Fanter NJ, Kenny RM, Baker CL, Baker CL. Surgical treatment of clavicle fractures in the adolescent athlete. Sports Health. 2015;7(2):137-141. doi:10.1177/1941738114566381

Murray IR, Foster CJ, Eros A, Robinson CM. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg Am. 2013;95(13):1153-8. doi:10.2106/JBJS.K.01275

Ou L, Yang L, Zhao J, Su W. Cutaneous paresthesia after internal plate fixation of clavicle fractures and underlying anatomical observations. Medicine (Baltimore). 2018;97(41):e12729. doi:10.1097/MD.0000000000012729

By Jonathan Cluett, MD
Dr. Cluett is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the U.S. national soccer teams.