Clavicle fracture.

Common mechanism

Fall onto the point of the shoulder

Most common site

Middle third (midshaft)

First-line

Sling 2–4 weeks

Surgery

Selective ORIF for displaced midshaft fractures

Imaging

Plain X-ray + selective CT

What a clavicle fracture is.

The clavicle (collarbone) is a slender S-shaped bone that connects the shoulder to the chest wall. It is one of the most commonly fractured bones in the body. The typical mechanism is a direct fall onto the point of the shoulder — classically cycling, mountain biking, rugby, or AFL.

Fractures are described by location: the middle third (most common), the lateral (outer) third, and the medial (inner) third. The middle-third fractures are the focus of most decision-making about surgical versus non-operative management.

How the diagnosis is made.

The diagnosis is usually obvious clinically — pain, deformity, and an inability to lift the arm after the inciting injury. Plain radiographs confirm the fracture and characterise its displacement, comminution and shortening. A CT scan is occasionally indicated for comminuted or atypical fractures.

The skin over the fracture must be examined — skin tenting from a bone fragment is a surgical emergency, as it can progress to skin necrosis and an open fracture.

Non-operative treatment.

Most clavicle fractures are managed without surgery:

• Sling immobilisation for 2–4 weeks for pain control.
• Pendulum and gentle range-of-motion exercises early.
• Active range from 4 weeks.
• Strengthening from 8–12 weeks.
• Return to contact sport at 3 months once radiological union is confirmed.

When surgery is considered.

The published evidence has refined the indications for surgical fixation over the past 15 years. Surgery is generally considered when:

• The fracture is displaced more than 2 cm (shortened by more than the diameter of the clavicle).
• The fracture is comminuted with a Z-type pattern.
• The fracture is open or threatens the skin.
• The patient is a high-demand athlete or manual worker in whom early functional return matters.
• The fracture has not united after several months of non-operative treatment (non-union).

The procedure (ORIF) involves an incision over the clavicle, reduction of the fracture, and fixation with a contoured plate and screws. The clavicle is a subcutaneous bone and patients are usually aware of the plate; a number elect to have it removed at 12 months or later. Bony union is reliable, return to contact sport is at 3 months, and the cosmetic and functional outcome is excellent in well-selected patients.

Lateral and medial third fractures.

Lateral clavicle fractures behave differently from midshaft fractures — the lateral fragment is often small and subject to displacement from the weight of the arm. Surgical fixation is considered more readily in displaced lateral fractures. Medial-third fractures are rare and usually managed non-operatively.

Rehabilitation protocol after clavicle fixation (ORIF).

The following protocol applies to patients who undergo surgical fixation of a clavicle fracture. Progression is guided by clinical assessment and radiographic healing — strengthening does not begin until the 8-week post-operative x-ray and surgeon review confirm adequate union.

Post-operative — immediate instructions

• Wean from sling after 1 week.
• Lift nothing heavier than a cup of tea for 6 weeks.

Weeks 0–2 — early protection

• Sling for 1 week only.
• Passive range of motion for neck, elbow, wrist and hand.
• Pendular (Codman’s) exercises for the shoulder.
• Scapula setting exercises.

Weeks 2–8 — progressive mobility

• Active-assisted shoulder range of motion in all directions.
• Progress to active shoulder range of motion as pain allows.
• Ensure dynamic scapula control throughout.
• No strengthening until after the 8-week post-operative x-ray and surgeon review.

View the recovery roadmap for the full five-phase journey, or visit For Physiotherapists to request protocols directly.

Frequently asked questions.

References.

1. McKee MD, et al. Operative versus nonoperative care of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2012;94(8):675–684.
2. Canadian Orthopaedic Trauma Society. Non-operative versus operative treatment of displaced clavicle fractures. J Bone Joint Surg Am. 2007;89(1):1–10.