An epidemiological analysis of clavicle fractures in young adults. Incidence, risk factors, and outcomes

Nº de DOI: 10.34896/RSI.2026.59.15.001

AUTHORS

1. Natalie Sofía Cárdenas Martínez. General Practitioner and Surgeon with a Master’s Degree in Occupational Health and Safety, with a concentration in Risk Prevention. Affiliated with ALEM CIA LTDA. Graduate of Universidad de las Américas. Based in Quito, Ecuador. https://orcid.org/0009-0006-0183-4498
2. Adriana Marcela Cevallos Noroña. General Practitioner. Affiliated with private healthcare institutions in Ecuador. Graduate of Universidad de las Américas. Based in Quito, Ecuador. https://orcid.org/0009-0005-9919-358X
3. Luis Gabriel Jimbo Lupercio. General Practitioner. Affiliated with private healthcare institutions in Ecuador. Graduate of Universidad de Cuenca. Based in Cuenca, Ecuador. https://orcid.org/0009-0006-1081-3189
4. Angie Daniella Lozada Guilcapi. General Practitioner with a Master’s Degree in Occupational Health and Safety. Affiliated with Laboratorio EcuaAmerican. Graduate of Universidad Regional Autónoma de los Andes (UNIANDES). Based in Coca, Ecuador. https://orcid.org/0000-0001-7427-2840
5. Brigette Valeria Pérez Guallichico. General Practitioner and Surgeon. Affiliated with Hospital Urgencias Médicas Tumbaco (HUMET). Graduate of Universidad de las Américas. Based in Quito, Ecuador. https://orcid.org/0009-0006-5457-4490

SUMMARY

The purpose of this paper is to provide a comprehensive examination of the epidemiology of clavicle fractures in the young adult population including the incidence, associated risk factors, mechanism of injury, and outcomes following treatment of fractures as a means to improve clinical practice and develop effective prevention strategies in this population.

KEY WORDS

Clavicle fractures, young adults, epidemiology, sports injuries, midshaft clavicle fracture, trauma, risk factors, radiography.

RESUMEN

El objetivo de este artículo es ofrecer un análisis exhaustivo de la epidemiología de las fracturas de clavícula en la población de adultos jóvenes, incluyendo la incidencia, los factores de riesgo asociados, el mecanismo de lesión y los resultados tras el tratamiento de las fracturas, con el fin de mejorar la práctica clínica y desarrollar estrategias de prevención eficaces para este grupo poblacional.

PALABRAS CLAVE

Fracturas de clavícula, adultos jóvenes, epidemiología, lesiones deportivas, fractura de la diáfisis clavicular, traumatismo, factores de riesgo, radiografía.

INTRODUCTION

Fractured clavicles (also referred to as «broken clavicles») are one of the most common orthopedic injuries seen in practice, particularly amongst young adults. Because they contribute substantially to musculoskeletal trauma and sports medicine, clavicle fractures are also one of the more problematic injuries. Due to the superficial location of the clavicle, the narrow area of its midshaft, and the mechanical forces acting on it as it transmits forces from falling or colliding with an object, the clavicle fractures easily among those under 25 years of age. Epidemiological studies indicate that the incidence of clavicle fractures peaks before 25 years of age and is primarily due to high-energy mechanisms, such as falling while participating in contact sports, riding a bicycle in an accident, or engaging in other vigorous activities associated with direct trauma to the shoulder. The anatomical configuration and biomechanical properties allow the clavicle to fracture easily; the midshaft is the location where most clavicle fractures occur due to this area having the greatest vulnerability based upon its thinness and the limited muscular support it receives. With the goal of preventing or managing these injuries, the risk factors and injury mechanisms associated with clavicle fractures must be understood. High-energy trauma has been classified into several mechanisms, with those affecting young adults most frequently resulting from falling forcefully, while the arm is by the side; being struck directly; or experiencing trauma from a traumatic collision. Additionally, lifestyle factors such as activity level (e.g., involvement in contact sports) place an individual at an increased risk of developing clavicle fractures. When there is no documented history of trauma, clinicians need to consider other differential diagnosis (e.g., malignancy; rickets; physical abuse) when determining the cause of fracture; thus, it is imperative that a clinician performs a thorough clinical evaluation. Diagnosis is primarily based upon history and physical examination, with radiography serving as the primary means to confirm the presence, location, and displacement of the fractured clavicle. Various treatment options are available for treating fractures of the clavicle; these include conservative treatment options (e.g., immobilization, activity modification, or physical therapy) to surgical interventions for displaced and/or comminuted clavicle fractures at high risk for developing non-union. Generally, outcomes after the treatment of clavicle fractures in young adults are favourable with the majority of subjects continuing to have good functional recovery; however, complications, including non-union, malunion, or cosmetic deformity, can occur if the clavicular fracture is not optimally managed.

OBJECTIVE

The objective of this paper is to provide a comprehensive analysis of clavicle fractures in young adults, with particular emphasis on their epidemiology, incidence, risk factors, mechanisms of injury, diagnostic approaches, treatment options, and clinical outcomes.

METHODOLOGY

This paper was developed as a narrative review of the literature focused on clavicle fractures in adolescent and young adult populations. Relevant scientific studies, orthopedic reviews, epidemiological analyses, and clinical publications addressing the incidence, mechanisms, diagnosis, management, and outcomes of clavicle fractures were reviewed and synthesized. Particular attention was given to studies describing age-related prevalence, the role of contact sports and other high-energy mechanisms, diagnostic imaging practices, and comparative treatment approaches. The selected information was organized into thematic categories to provide a structured overview of the epidemiological profile of clavicle fractures and their clinical relevance in young adults. This methodological approach allowed the integration of evidence from multiple perspectives, including orthopedic trauma, sports medicine, radiologic diagnosis, and rehabilitation, in order to provide a broad and clinically useful understanding of this injury.

RESULTS

What is the prevalence of clavicle fractures among young adults compared to other age groups?

The occurrence of clavicle fractures has demonstrated a unique age-creeping tendency. Of the groups (> 0-90 years), young adults were most affected compared to other age cohorts. According to multiple publications, the occurrence of clavicle fractures peaked amongst adolescents and young adults – markedly as it relates to males aged 15-24 y – eliciting a great deal of the overall sample (i.e., 24%)¹. Another piece of literature indicated that the mean age for clavicle fracture occurrences was 29.3 years of age; this clearly demonstrates the greater risk in young adults vs. the elderly demographic at large, which peaked between the ages of 20-35 years of age². The increased incidence of clavicle fractures in this group can be attributed to the high level of participation in higher risk activities (i.e., sports), which is more common in this young-adult category than in others³. Amongst the normal population, there is a unique bimodal distribution of clavicle fractures across the life span: after 20 years of age the incidence drops significantly; thereafter, following the beginning of age-related decreases in bone-mineral density (i.e., secondary to osteoporosis), we have a second incidence demographic (i.e., women > 70 years) due to activity-related fall causing osteoporosis-related morbidities^1,2. However, excluding women > 70 years, the overall risk of clavicle fractures decreases significantly with age^2,3. These epidemiological trends warrant the necessity of initiating consequences on targeted prevention strategies affecting young adults, particularly males (i.e., through the implementation of appropriate sports safety guidelines, injury prevention programs), whilst concurrently addressing issues relating to bone health and fall prevention in the elderly female population to prevent the occurrence of the second peak of fractures that usually occurs in the elderly.

How do contact sports influence the epidemiology of clavicle fractures in young adults?

Participation in contact sports has a significant influence on the epidemiology of clavicle fractures among young adults due to the high-impact collisions and falls that occur during these types of activities. Football, soccer, and bicycling are the major contributors to clavicle fractures within this age group and therefore determine the distribution and frequency of clavicle fractures in this population⁴. Among young adults, contact sports are responsible for an estimated 45% of all clavicle fractures reported⁴. The incidence of clavicle fractures is particularly high in football and soccer, with football accounting for 12% of all sport-related clavicle injuries and soccer accounting for 6%; this suggests a direct relationship between the type of sport and the risk of injury⁴. In addition, there is a striking difference between males and females in regard to age-related risk of clavicle fracture; males, particularly those between the ages of 10 and 19 years, have an increased incidence of clavicle fractures as a result of increased participation in these types of physically challenging sports and inherent differences in the biomechanics of males and females⁴. The relationship between participation in sports, gender, and age indicates that there is a need for targeted prevention strategies and education interventions that will address the risk factors associated with clavicle fractures in high at-risk groups of athletes who participate in contact sports.

What are the primary mechanisms leading to clavicle fractures in young adults?

The majority of clavicle fractures occur among young adults due to high-energy trauma. The primary mechanism for most young adult clavicle fractures is traumatic falls. If an individual falls while landing on their outstretched arm or with their arm fully extended, the clavicle receives substantial axial and compressive forces, resulting in a fracture of the clavicle^5,6. The risk of fractures among athletes is exacerbated by the frequency of direct trauma to the shoulder and high-velocity collisions associated with many popular sports, making athletic participation a significant risk factor for clavicle fractures^6,7. Furthermore, motor vehicle accidents are another common cause of clavicular injuries in this age group and can occur from both direct and indirect mechanisms (e.g., impact with the dashboard, lateral impact) as the shoulder or clavicle receives high loads during an automobile accident⁶. The relationship among these three mechanisms (falls, sports, and motor vehicle accidents) highlights the need for preventative measures regarding the incidence of clavicle fractures in young adults, including education on protective equipment, safe participation in sports, and safety education for motorists.

How do lifestyle and activity level contribute to the risk of clavicle fracture?

The likelihood of sustaining a clavicle fracture is closely linked to lifestyle habits and levels of activity because those who engage in strenuous or high-impact activities are over represented in terms of sustaining this type of joint injury. Participation in contact sports, such as rugby and football, or activity types, such as cycling, significantly increases the potential for experiencing an incident in which a fall or collision will occur and, consequently, results in clavicle fractures⁸. The mechanism of how these injuries occur primarily relates to how an individual lands following a fall or injury; therefore, the specific physical behaviours that are inherent to an individual’s lifestyle may have a direct impact on their risk of sustaining a clavicle fracture⁸. Overall, the information presented provides a basis for establishing a clear relationship between lifestyle habits, activity level and the occurrence of clavicle fractures. Those who participate in high levels of dynamic and/or high-energy activities have an increased risk for sustaining the first clavicle fracture and may be at risk for reinjury should they return to activity before they are fully recovered⁹. To prevent the occurrence and reoccurrence of clavicle fractures among active individuals, it is important to utilise a comprehensive approach that incorporates injury prevention strategies, educating athletes and coaches about safe participation and ensuring that all individuals adhere to the recovery protocols appropriate for their particular injury.

How are clavicle fractures typically diagnosed and what is the role of radiography?

The most reliable way to diagnose a clavicular fracture is through a multimodal method that incorporates imaging and clinical evaluation, radiography being considered the first line diagnostic method [10]. Typical clinical signs including constant pain radiating from the site of the fracture, abnormal mobility of the shoulder, and shoulder weakness may provide an indication that a clavicle fracture has occurred; however, these clinical features alone are often inadequate in making an accurate diagnosis due to the complex anatomy and possibility of injury to other structures in the region¹⁰. Standard radiography, utilizing both anteroposterior (AP) and axial views should be used first to demonstrate the entire extent of the clavicle (from both acromioclavicular and sternoclavicular joints) ^10,11,12. The unique S-shape of the clavicle combined with its overlay on the ribs and lungs may limit the ability to make an accurate diagnosis using standard radiographs; therefore, specific views and angling to obtain clear images are necessary^10,12. Alternative radiographic views, such as the Zanca or serendipity views, may also be necessary to obtain diagnostic images, and a DACBR can make a significant contribution to the interpretation of such imaging by assisting in obtaining the appropriate view for accurate diagnosis¹⁰. The relationship of clinical and radiographic imaging indicates that careful attention is required in combining these modalities in producing optimum outcomes for the client. Hence, the value of highly qualified individuals in following strict protocols during the examination process is essential.

What are the current nonoperative and operative treatment options, and when are each indicated?

Non-operative and operative treatment modalities represent the two main types of options currently available for managing clavicular fractures. Treatment choice will depend on several factors such as the nature/complexity of the injury, the age of the patient, their activity level, and their medical history. Non-operative treatment represents the mainstay of care for almost all types of minimal displaced/mid-shaft clavicular fracture; patients seeking to avoid surgical approaches will prefer an option that facilitates recovery at the lowest possible price with no unreasonable risk of complications, while also allowing them to recover as quickly as possible¹³.

Typically, non-operative (conservative) treatment approaches are less invasive than surgery, have lower rates of complications associated with their use, reduce pain levels and improve mobility while decreasing downtime. Accordingly, non-operative (conservative) treatment options are best suited for patients who have suffered mild to moderate clavicular fractures and/or any patient who wishes to avoid surgical intervention.

However, in cases of high grade/displaced/comminuted fractures, patients might require an operative management option to achieve the following goals: (1) restore anatomical alignment, (2) facilitate early mobilization, and (3) achieve optimal functional and cosmetic outcomes¹³. Before determining the appropriate intervention option between non-operative and operative management, decisions must be made after performing a thorough assessment of the injury, and considering the patient’s desires and long-term goals, which supports developing an individualized care plan and conducting a multidisciplinary evaluation to assist in clinical decision making¹³.

What are the expected recovery outcomes and potential complications in young adults with clavicle fractures?

Although there has been a lot of recent investigations done to understand why the anatomical locations on the human body bear greater risk than others with respect to the various types of orthopaedic injuries, research that examines the outcomes of recovery from, and the complications associated with, clavicle fractures in young adults remains severely limited and of low quality¹⁴. Nevertheless, existing evidence suggests that adolescents generally heal very well from their clavicle fractures without surgical intervention and that non-operative treatment offers several important benefits to the young adult population¹⁴. Furthermore, it has been shown that the chance of experiencing a ‘failed’ skeletal healing event is extremely low in adolescents and therefore, there is a significantly reduced likelihood of developing complications such as non-union or malunion after receiving conservative treatment for clavicle fractures in this group of patients¹⁴. The relationship between the method of treatment and the resulting clinical outcomes indicates a strong need for treating adolescents according to their high potential for successful healing while eliminating any unnecessary risk associated with surgical interventions. There is also a strong demand for additional high-quality, and age-appropriate, research which could assist in identifying the most appropriate methods of management to optimize recovery results and minimize complications for this population given the previously described limitations of the current body of evidence¹⁴.

DISCUSSION 

The purpose of the analysis was to gain a better understanding of the causes of clavicle fractures within the adolescent (ages 10-19) and young adult (ages 20-25) populations. The results indicated that clavicle fractures are prevalent in both age groups and are the result of a variety of factors or causes. The incidence of clavicle fractures was highest in the adolescent and young adult populations, especially among males who participate in high-impact sports. The data is consistent with previous research indicating that high-impact contact sports (football, soccer, etc.) are the leading cause of clavicle fractures in this age group. In addition, high-energy-trauma mechanisms (falling, motor vehicle accidents) accounted for a significant proportion of clavicle fractures in the sample reviewed. Therefore, it appears as though injury prevention strategies for high-risk activities could be beneficial in preventing or reducing clavicle fractures in young adults. There are anatomical and biomechanical predisposing factors that contribute to the risk of clavicle fractures (e.g., genders).

The use of clinical and radiographic measures for the diagnosis of an individual with a clavicle fracture is consistent with what is currently considered to be best practice. While nonoperative treatment may provide good outcomes for displaced clavicle fractures, there is a lack of high-quality, intact, long-term outcome data to conclusively establish appropriate rehabilitation guidelines for each patient. Nonoperative management may also yield good outcomes for patients with displaced fractures but again, there is a lack of quality research proving optimal therapy. Additionally, there is evidence that supports the idea that individuals without trauma history may have psychological or other developmental or neurobehavioral effects as predisposing factors for clavicle fractures, and further investigation is needed to determine how to increase the diagnostic accuracy for a clavicle fracture.

The limitations identified in this review were the heterogeneity of the design of studies reviewed and the potential for selection bias in the studies reviewed, which limits the generalizability of the results found in this review. Future research should focus on conducting well-controlled, prospective studies to evaluate the treatment outcomes, rates of re-injury and recovery, and the overall long-term impact of clavicle fractures on the biomechanics and quality of life of young adults. As such, the results of this review provide evidence of the need for targeted prevention strategies (e.g., preventative methods) – promotion of safe sports participation, education about sports injuries and to develop individualized treatment strategies based on the activity level of the patient and the anatomical characteristics of the patient. Additional research will need to be completed to build a stronger evidence base to develop guidelines for the optimal management of clavicle fractures in at-risk populations.

CONCLUSIONS

1. Clavicle fractures are among the most common orthopedic injuries affecting adolescents and young adults, particularly males involved in high-impact sports and other vigorous physical activities. Their high incidence in this population reflects the interaction between anatomical vulnerability, biomechanical stress, and frequent exposure to high-energy trauma such as falls, direct blows, and motor vehicle accidents. The midshaft of the clavicle remains the most commonly affected site due to its structural characteristics and limited muscular reinforcement.
2. The findings of this review indicate that lifestyle and activity level play a substantial role in determining risk, especially in individuals who regularly participate in contact sports or high-velocity recreational activities. Accurate diagnosis depends on a careful clinical history, physical examination, and the appropriate use of radiographic imaging to determine fracture location, displacement, and severity. These elements are essential for selecting the most suitable treatment strategy.
3. Both nonoperative and operative management remain important options in current practice. Conservative treatment is generally effective for minimally displaced fractures and is associated with favorable recovery in most young adults. Surgical intervention, however, may be necessary in displaced, comminuted, or high-risk fractures to restore alignment and optimize functional outcomes. Although overall prognosis is generally good, complications such as non-union, malunion, persistent pain, and cosmetic deformity may occur if treatment is delayed or inadequate.
4. Clavicle fractures in young adults represent a relevant clinical and public health issue due to their frequency, association with sports participation, and potential impact on function and quality of life. Strengthening prevention strategies, promoting safe participation in high-risk activities, and improving individualized treatment planning are essential steps to reduce the burden of these injuries. Further high-quality prospective studies are needed to better define long-term outcomes, rehabilitation protocols, and evidence-based management strategies for this population.

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