What is a distal clavicle fracture?

A distal clavicle fracture is a complete or incomplete break (fracture) in the outer third of the collarbone (clavicle) near where it attaches to the shoulder blade (acromion). This fracture is considered separately from fractures elsewhere in the clavicle, because of its’ more tendency to heal slowly or not at all.  This fracture can also extend into the articulation between the acromion and clavicle (the AC joint) and can lead to arthritis of that joint.  Fractures in the distal third can also be associated with ligament injuries to the ligaments, which support the shoulder girdle.

How our shoulder experts can help

Our shoulder experts will diagnose and treat your condition using the latest advances in orthopaedic technology. To request an appointment with our physicians, please call 202-833-1147.

How does a distal clavicle fracture occur?

• Usually, a direct blow to the shoulder, falling on the tip of the shoulder, or impact to the point of the shoulder
• Less commonly, an indirect stress, such as falling on the outstretched hand or on the tip of the elbow

What increases the risk of fracture?

• Sports that involve contact or collision, such as football, soccer, hockey or rugby
• Sports with high risk of falling on the shoulder, such as mountain biking, cycling or rodeo riding
• Inadequate protective equipment
• Decreased bone density, such as osteoporosis

What are the of distal clavicle fracture symptoms?

• Pain, tenderness and swelling on top of the shoulder
• Deformity or bump due to fracture displacement
• Bruising at the site of injury, usually within 48 hours
• Loss of strength with use of the affected arm (usually due to pain)
• Coldness or numbness may occur due to the proximity of adjacent nerves and vessels, but is rare
• Uncommonly, shortness of breath or difficulty breathing

How is it diagnosed?

Diagnosis is straightforward, with prominence along the course of the distal clavicle and a fracture seen on X-ray.

How is it treated?

Non-operative treatment: Initial treatment consists of pain medication, ice and compressive dressing to relieve pain and reduce swelling. Use of a shoulder immobilizer, figure-of-eight brace or arm sling is usually recommended.  Despite the risk of non-union, which approaches approximately 20percent, even some of these can be asymptomatic.

Operative treatment: In the upper extremity of a throwing athlete, consideration may be given for operative intervention.  Another indication is in the patient with significant displacement and objectionable cosmetic appearance.  Many operative alternatives have been described, including the use of a plate and screws, pin fixation, or a new technique using a device called the “tightrope,” in which a small open incision is complemented by arthroscopic placement of a device, which reduces and maintains fracture position during healing.

Treatment Complications:

Possible complications of non-operative treatment include:

• Persistent deformity
• Painful (or painless) delayed or non-union
• Fatigue and pain with overhead activities, especially in an overhead athlete.

Possible complications of operative treatment include:

• Surgical complications not specifically associated with AC joint repair/reconstruction, such as pain, bleeding (uncommon), infection (<1percent), nerve injury (uncommon), stiffness, problems with anesthesia, and inability to return to previous level of pre-injury activity.
• Failure to unite
• Failure of fixation with recurrent deformity:

When can you return to your sport or activity?

A sling is usually necessary for four to six weeks, depending upon the degree of displacement and symptoms.  Therapy exercises to restore mobility begin in the first week or two following surgery, but are progressed slowly in deference to fracture healing.  Strengthening is advanced when the fracture appears healed, which may be as early as 6 weeks, but often will take longer.  These are usually carried out under the care of a physical therapist or athletic trainer.  Return to sports usually requires three to four months.

How can a clavicle fracture be prevented?

• Care in playing contact/collision athletics
• Proper shoulder pad/protective equipment
• Maintain appropriate conditioning, particularly neck, shoulder and arm muscle strength and endurance, as well as flexibility
• Use proper technique and have a coach correct improper technique (including falling)