Displaced clavicle fracture before and after Surgery

 

 

Clavicle- AKA Collar Bone

 

Fractures of the clavicle or collarbone are relatively common injuries in adults.  The majority of clavicular fractures can be treated effectively with immobilization in a figure of 8 brace when they are well aligned. A small percentage of fractures benefit from surgical repair and the number of patients undergoing repair is increasing as the results of surgical repair have shown clear benefits over non-operative treatment.  Indications for surgical treatment include large amounts 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 bicycling accidents in which the rider goes over the handle bars.  Surgical repair involves making an incision over the collar bone and fixation with titanium 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.  Many patients 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.

 

I have begun repairing more of these fractures in the past couple of years for a couple of reasons.  The first is that 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 repative lifting of the arm within a week and don't require strong pain medication.  The second 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 conservative treatment.  Patient have much less pain and much faster return to normal activities with repair which leads to improved quality of life, especially in the short term.  Finally, many of these fractures heal with significant cosmetic deformity which I find to be an issue especially with younger women.   In short, I believe the benefits of surgical repair far outweigh the risks of surgery in a vast majority of patients.  There is evidence based medicine that suggests that repairing the clavicle gives far better short term result than non-operative management.  The manuscript which I have a link to 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

 

I generally use a titanium or stainless steel clavicle repair plate.  The surgery takes roughly one hour and is done as an outpatient procedure meaning you go home the same day as the surgery and don't stay overnight in the hospital.  Most patients report dramatic improvement in discomfort 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. This is far more common in women that men. I've included link to the manufacturers of the plates I most commonly use

 

Titanium Clavicle Plates

 

 

 Accumed Plating System- click here to the web link for this implant

 

 

Stainless Steel Clavicle Plates

 

 

                                        

 

 

 

Synthes Plating System- click here for the web link to this implant

 

Most patients recover quickly after surgery to repair the clavicle and are able to move their arm fully on their initial post operative visit.  To view my post-op shoulder fracture instruction sheet, click on the link below.

 

 

Post-Op Shoulder Fracture Instruction Sheet