Clavicle Fracture in Vienna
A fall onto the shoulder, a crack, and the arm can no longer be lifted: a broken collarbone particularly often affects people who cycle or do contact sport. I assess how the fragments are positioned and discuss with you whether a sling is enough or stabilisation is necessary.
In short
A clavicle fracture (broken collarbone) affects the bone that connects the breastbone with the acromion. It almost always results from a fall onto the shoulder, most often in cycling and contact sport. Typical signs are sharply localised tenderness, a palpable step and a shoulder that hangs forwards and downwards. The diagnosis is confirmed with an X-ray. If the fracture is well aligned, immobilisation in a sling is enough; with marked displacement, shortening, an open fracture or involvement of the acromioclavicular joint, I stabilise it with a plate and screws.
What is a clavicle fracture?
The collarbone (clavicle) is the only bony link between arm and trunk. It runs in a flat curve from the breastbone to the acromion and holds the shoulder away from the chest. When it breaks, this strut is missing: the shoulder sinks forwards and downwards, and lifting the arm becomes painful. Because the bone lies directly under the skin, a malposition can usually be seen and felt.
The bone has three sections. The middle section breaks by far the most often: it is the narrowest part, lies where the two curves merge, and is not held by any strong ligament. Through it the force of a fall onto the shoulder travels to the trunk — typically in a fall over the handlebars, in the snow or in a tackle. The outer section lies at the acromioclavicular joint (AC joint); if the ligaments to the coracoid process tear as well, the fracture becomes unstable. The inner section at the breastbone rarely breaks.
Typical symptoms
- Sharply localised pain over the collarbone — it increases with every arm movement
- A palpable or visible step — the fragments are offset
- A drooping shoulder — it sinks forwards and downwards
- A protective posture — the arm is held against the body and supported with the other hand
- Swelling and bruising — along with taut skin over the fracture site
- Warning signs — numbness, a cold hand or shortness of breath need assessment at once
How I make the diagnosis
First I ask you to describe the fall. Then I palpate the collarbone along its whole length and check the skin over the fracture site as well as circulation, sensation and strength in the arm. I also examine the acromioclavicular joint and the joint at the breastbone, because they cause similar symptoms. I assess bruising and soft tissue with ultrasound in the practice. For the bone I arrange an X-ray; it shows the level of the fracture, displacement and shortening. For fractures at the inner end I additionally arrange a CT scan.
Treatment: conservative first
A fracture with good bone contact and no shortening usually heals without an operation. The arm goes into a sling that takes its weight and relieves the fracture ends. The figure-of-eight bandage that used to be common offers no advantage and often presses into the armpit. How long immobilisation is needed depends on the course of healing, not on the calendar.
You move your fingers, wrist and elbow from the start so that nothing stiffens; as soon as the pain allows, guided exercises are added. Physiotherapy and exercise therapy are in the same building at the Orthozentrum Döbling. Follow-up images show whether the position holds; if the fracture slips, I discuss stabilisation with you again.
When stabilisation is necessary
Arguments for a procedure are marked displacement with no contact between the fracture ends, shortening, an open fracture and skin stretched white over a tip of bone. The same applies to an injury to vessels or nerves and to an outer fracture with torn ligaments to the coracoid process; this case borders on the dislocation of the AC joint with a raised collarbone.
The usual method is plate osteosynthesis (stabilisation with a plate): I reduce the fragments, restore length and alignment, and anchor a pre-shaped plate with screws. The aim is a stability that allows early guided movement. I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
I tell you beforehand what may remain. Without an operation the bone forms a callus (newly formed bone) at the fracture site that remains palpable as a thickening and, in slim people, visible. After stabilisation, the scar and the plate remain; the plate can often be felt under the thin skin and may be a nuisance under rucksack straps. It can be removed in a second, smaller procedure once the fracture has healed in bone.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. More on how a private practice works. Related topics are shoulder dislocation and instability, persistent shoulder pain and sports orthopaedics in Vienna; the page on the shoulder specialist in Vienna gives an overview.
Whether the sling is sufficient or the plate is the more reliable route depends on the X-ray, your occupation and your sport. I make this decision together with you once the findings are available.
Frequently asked
Common questions about the clavicle fracture
A typical sign after a fall onto the shoulder is immediate pain over the collarbone that you can pinpoint. Often a step can be felt, the shoulder hangs forwards and downwards, and the arm is supported with the other hand. Every movement above shoulder height hurts. The step is a clear sign, but it does not replace the X-ray.
No. If the fracture is well aligned and the bone is not shortened, it usually heals without an operation; the arm is immobilised in a sling and progress is checked with X-rays. Arguments for stabilisation are marked displacement, shortening, an open fracture, skin stretched tight over a fragment and involvement of the acromioclavicular joint.
Through an incision along the bone I reduce the fragments and restore length and alignment. I then place a pre-shaped plate on the bone and anchor it with screws. The aim is a stability that allows early guided movement. I carry out the procedure at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus.
Not necessarily. The collarbone lies directly under the skin, so the plate can often be felt and may be a nuisance under a rucksack strap or when lying on that side. If it bothers you, I remove it in a second, smaller procedure once the fracture has healed in bone.
That does happen, and I say so openly. Without an operation the bone forms a callus at the fracture site that remains palpable as a thickening and, in slim people, visible. After stabilisation, a scar, the palpable plate and sometimes a numb patch of skin beneath it remain. Shoulder mobility usually does not suffer as a result.
You should have a fracture assessed immediately if the skin over the bone is stretched white or has already been pierced. The same applies to numbness, tingling or loss of strength in the arm, to a cold and pale hand, and to shortness of breath after the fall. These signs are rare, but when they occur they belong in the emergency department.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.