Collarbone (clavicle) fracture treatment

A broken collarbone can usually be treated in one of two ways: without surgery, allowing the bone to heal in a sling and then rebuilding motion and strength; or with surgery, in which the bone is repositioned and held with a plate and screws while it heals. Most collarbone fractures are treated without surgery.

Which path fits is decided for the individual injury and person. Importantly, the position of the bone is only one part of that decision — displacement by itself does not automatically mean an operation is needed. The examination, the condition of the skin, associated injuries, and your health, activity, and goals all matter.

Nonsurgical treatment supports the arm — usually with a sling — while the collarbone heals. Early on, the focus is comfort and protecting the fracture while keeping the elbow, wrist, and hand moving. As healing progresses, shoulder motion is gradually restored and then strength is rebuilt, guided by how the bone is healing on examination and X-ray.

Many people heal well this way. A visible bump at the fracture site is common as the bone heals and does not by itself mean the result is a problem. Follow-up visits track healing, and the plan can be adjusted if the fracture shifts or is slow to heal.

Surgery is considered in selected situations rather than for every fracture. Factors that may lead to a discussion about an operation include:

• Bone ends that are substantially out of place or shortened
• Skin over the fracture that is tented or at risk of breaking down
• An open fracture (a wound connecting to the broken bone)
• Certain associated injuries, or several bones injured together
• A fracture that is not healing with nonsurgical care

These factors are weighed together, not applied as a checklist, and reasonable surgeons may reach the operation decision slightly differently for a borderline injury. The goal is to match the treatment to your specific fracture and circumstances after a clear conversation about the trade-offs — including that surgery adds the considerations of an operation, and that nonsurgical care means accepting a period of support while the bone heals on its own.

The most common operation for a collarbone fracture is open reduction and internal fixation, or ORIF. Through an incision over the collarbone, the surgeon repositions the bone fragments (the reduction) and secures them, typically with a contoured plate and screws, so the bone can heal in a good position. In some fractures other fixation is used; the specifics depend on the fracture and are decided by your surgeon.

After surgery, the arm is supported for a period, and rehabilitation follows a staged path — early protected motion, then a gradual return of motion and strength as healing allows. Because the bone was fixed, the early plan differs from nonsurgical care and follows a dedicated protocol.

Both nonsurgical care and surgery are followed by a staged rehabilitation program: an early protective period, then restoring motion, then rebuilding strength, with a return to fuller activity and — when relevant — sport guided by healing and clearance rather than the calendar alone.

The two paths have different early restrictions, so they follow different protocols: a non-operative clavicle fracture protocol and a clavicle ORIF protocol. Both are linked below and describe the general progression; the specific restrictions and timing are set by your care team, and your operative note takes precedence when surgery was performed.

Every treatment has trade-offs. With nonsurgical care, the main considerations are that some fractures are slow to heal, do not heal, or heal in a position that leaves symptoms, which can prompt a later conversation about surgery. Surgery carries the considerations of an operation. The possibilities below are for discussion with your surgeon and are not a complete list:

• Infection
• Problems with healing, including slow healing or a fracture that does not heal
• Irritation from the plate or hardware, which sometimes leads to later removal
• Numbness in the skin below the incision
• Nerve or blood-vessel injury (uncommon)
• Stiffness, or a need for further treatment or surgery

The goal of treating a collarbone fracture — with or without surgery — is a healed bone and a shoulder that works well for your daily life and activities. Most people do well, recovery is gradual and individual, and the right path is the one matched to your specific fracture after a clear conversation with your surgeon. Whether an operation is part of that plan is an individual decision, not an automatic one.