Clavicle Fracture

Fractures of the clavicle or collarbone are relatively common injuries in adults. The majority of clavicular fractures can be treated effectively with immobilization. The number of patients undergoing repair is increasing as the results of surgical repair have shown clear benefits over non-operative treatment. Patients who undergo surgical repair are able to move the arm without pain within a short period of time after surgery and have a much faster recovery and return to work. Indications for surgical treatment include a large amount of angular deformity, shortening of the clavicle more than 1.5 cm and segmental fractures. These types of fractures typically occur after high energy injuries such as cycling accidents in which the rider goes over the handle bars.

clavicle-fracture

Surgical repair involves an incision over the collar bone and fixation with titanium or stainless steel plates and screws. Early return of function can be expected and most patients are able to reach overhead without pain within 5-7 days of surgery. Thinner patients and women commonly have irritation over the plate and elect to have the plate removed after the bone heals, generally in the range of 8-12 months after fixation.

Orthopedic surgeons have begun repairing more of these fractures. With the uncertain economic climate, many patients are anxious to return to work quickly and being out on disability for 4-6 weeks in a sling represents a financial hardship for many individuals. Most patients can return to work with light lifting and repetitive lifting of the arm within a week and do not require strong pain medication. Another benefit is that long term shoulder function may be improved with repair of the clavicle. The rate of non-union, failure of the bone to unite after a fracture, is much less with surgical repair than non-operative treatment. Patients have much less pain and much faster return to normal activities with repair. Finally, many of these fractures heal with significant cosmetic deformity which is often an issue.

The link below is a randomized, prospective study (the highest level of evidence possible) comparing non operative treatment with surgical repair. This study demonstrated a clear benefit to repair of the clavicle using plates and screws.

Mckee et al, JBJS 2008

The surgery takes roughly one hour and is done as an outpatient procedure, meaning you go home the same day as the surgery. Most patients report dramatic improvement in pain and shoulder function within the first week after surgery. The risks of surgery are infection (about 1%), wound problems (0.5%) and numbness around the chest area (10-15%). The numbness is caused by stretching of the nerves around the incision and usually resolves over a 6-8 month period. The risk of non-union (failure of the bone to unite) is less than 2% with operative intervention vs. about 10% with non-operative management. About 1/3 of patients have some irritation over the plate after the bone heals and request to have the bone plates removed.

Post-Op Shoulder Fracture Instruction Sheet