Clavicle (Collarbone) Fractures

Clavicle (collarbone) Fractures are very common injuries.  If a Clavicle Fracture is not significantly displaced (moved) or angled (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 may be preferred.

If a Clavicle Fracture is shortened 1.5 cm or more, significantly displaced (so that there’s no bony contact), significantly angled (bent) or comminuted (in many pieces), then it will probably do better if it is surgically repaired, especially  in an active individual.  This is because if the Clavicle Fracture is allowed to heal in a shortened or otherwise unsatisfactory situation, shoulder pain, stiffness, dysfunction, decreased endurance, and weakness can occur, especially during overhead activities or activities requiring shoulder strength.  And once a Clavicle Fracture is healed in a shortened or otherwise unacceptable position, the muscles of the shoulder and the shoulder blade may contract and become permanently too short, or stretch to become permanently too long, depending on how the Clavicle Fracture healed.  This can lead to permanent weakness and loss of endurance, even if the Clavicle Fracture is treated at a later time.  As with most injuries, the best chance to obtain a good result is early after the injury occurs.

Surgical repair of a Clavicle Fracture is performed as an outpatient, same-day, surgery.  The best way to fix most serious clavicle fractures is by using specially molded plates that conform to the Clavicle.  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 begin.  Active using the shoulder should be avoided for 4-6 weeks, and during that time a sling should be worn in public 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 Clavicle Fracture Repair.

Smoking greatly increases the risk of Clavicle Fractures not healing (i.e. going on to ‘non-union’), whether or not surgery is performed, and so quitting smoking is very helpful.

An unhealed Clavicle Fracture (Clavicle Non-union), is a more difficult problem to fix.  Clavicle Non-unions usually involve some degree of shortening and deformity, 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 the hip).  Taking bone graft from the iliac crest is somewhat painful, although with newer instruments this can be done using a minimally invasive technique, so it’s not as bad as it used to be.  A specialized plate is used to stabilize the Clavicle Nonunion.  Roughly 3-4 months after surgery, a CT scan will be ordered to confirm that the Clavicle Nonunion has healed.

In conclusion, most 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.