Clavicle (collarbone) fractures are very common injuries. If the clavicle fracture is not significantly displaced (translated) or angulated (bent), then it can be treated in a sling for 6 weeks. For people who do a lot of deskwork, a ‘figure-8’ brace that leaves the arms free is also fine, and may be preferred.
If the clavicle fracture is shortened 1.5 cm or more, or significantly displaced (no bony contact), significantly angulated (bent) or comminuted (many pieces), then it will probably do better if it is surgically repaired, especially in an active individual. If the clavicle fracture is allowed to heal in a shortened or otherwise unsatisfactory situation, pain, stiffness, dysfunction, decreased endurance, and weakness can occur, especially during overhead activities or those requiring shoulder strength. Once a clavicle fracture is healed in a shortened position, the muscles of the shoulder and shoulder blade may become inappropriately shortened or lengthened, which can lead to permanent weakness and loss of endurance, even if treated at a later time. As with most injuries, the best chance to obtain a good result for a clavicle fracture is early after the injury occurs.
Clavicle fixation is performed as an outpatient, same-day, surgery. The best way to fix most serious clavicle fractures is with specially molded plates that conform to the clavicle and locking screws. After surgery, computer use and deskwork can be performed the following day. Showering is fine 3 days after surgery, at which point elbow, wrist and hand motion may also begin. Active shoulder use should be avoided for 4-6 weeks, and a sling should be worn in public for 4-6 weeks for protection. Clavicles often take 3 months to heal. A CT (cat) scan is often ordered 6-12 weeks after surgery to ensure that the bone is healed. Most patients usually do very well following surgical fixation of clavicle fractures.
Smoking greatly increases the risk of clavicle fractures not healing, whether or not surgery is performed, and so quitting smoking is very helpful.
An unhealed fracture, known as a non-union, is a more difficult problem to fix. Clavicle non-unions usually involve some degree of shortening, which may be difficult to fully correct. In order to fix a clavicle non-union, it is often necessary to take bone from the iliac crest (the rim of bone above your hip), which is somewhat painful, although with the small instruments we now have to drill into the bone using a minimally invasive technique, it’s not nearly as bad as it used to be. Again, a specialized plate is used to stabilize the clavicle fracture. Healing is confirmed with a CT scan.
In conclusion, clavicle fractures usually don’t require surgical fixation, but when they do, modern techniques and equipment help produce an excellent result in the vast majority of cases.