The clavicle is commonly known as the “collar bone.”  A fracture is a broken bone.  And so a  clavicle fracture is a broken collar bone.  Clavicle fractures usually occur as the result of a fall onto the shoulder.  They may also result  from a direct blow to the clavicle or a fall onto an outstretched hand.  They may be  nondisplaced (just cracked) or displaced (the broken fragments are pulled apart).  Most clavicle  fractures occur near the middle of the shaft.  Some fracture occur one of the ends of the  clavicle.   Clavicle fractures are diagnosed based on a history, physical exam, and x-rays.  Patients  usually report a fall or a blow to the shoulder.  They complain of pain and sometimes a  deformity and swelling over the collar bone. Upon physical exam, the shoulder may be bruised and swollen over the clavicle.  The broken  bone will, of course, be tender to push on.  More severe clavicle fractures may result in an  obvious deformity.  When this is the case, it is important to ensure that the sharp fragment is  not threatening to poke through the skin.  This is known as “tenting” of the skin. X-rays are important not only to confirm that the clavicle is broken, but to evaluate the fracture.   Fractures may be non-displaced (just a crack) or displaced.  They may involve the cartilage in  the joint (intra-articular).  The fragments may overlap one another, resulting in shortening of the  clavicle. Non-displaced clavicle fractures and clavicle shaft fractures that have less than 1-2 cm of  displacement or shortening can be treated without surgery.  The arm is placed in a sling,  shoulder immobilizer, or figure-of-eight brace.  The shoulder is immobilized in this way for 4-6  weeks as the bone heals.  Strenuous activity is not permitted until significant healing has  occured.  Follow-up x-rays are obtained to evaluate healing and will demonstrate callus  formation at the fracture site.  Range-of-motion exercises with the elbow and wrist are  encouraged to prevent stiffness.   If the clavicle fracture is too displaced or shortened (greater than 1-2 cm), if the broken  fragments have poked through the skin or threaten to break through the skin, or if there is a  displaced fracture at the end of the clavicle, surgery may be indicated.  Surgery involved  pushing the broken fragments back into placed and fixing them together with hardware such as  a plate and screws.  This is called open reduction- internal fixation or ORIF.