Clavicle fractures, or fractures of the collar bone, are very common injuries. They often occur from a direct blow to the shoulder from a fall. This type of injury occurs frequently in equestrian sports and cycling, when the person is thrown off of the horse or bicycle onto the shoulder.
When the clavicle breaks, bleeding occurs around the break, causing swelling, discomfort, and pain. Pain worsens when the arm moves as the broken bones rub against each other. A sling to rest the arm, ice, and pain medication will help keep discomfort to a minimum.
Our long term goal is to ensure the broken bone has the best chance of healing, and that it heals in the proper position to allow full use of the arm.
Each collar bone fracture is treated differently, depending upon the location of the break and its severity. Treatment, whether surgical or nonsurgical, should be decided within the first week, as surgery should be performed within two weeks from the break.
Nonsurgical treatment involves the use of a sling for comfort, with use of the arm as tolerated. Occasionally a brace is recommended. The sling can be taken off after one to two weeks when the pain subsides. I usually instruct patients to avoid overhead use of the arm for four weeks, and avoid heavy lifting until healing. The fracture will usually heal after six to eight weeks, when normal use of the arm can begin. Formal physiotherapy is rarely required. The benefits of this treatment are that risks of surgery are avoided. In fractures with little separation, full and normal function is likely achieved with this form of treatment.
Surgery is usually considered for fractures that have a large separation. Recent research has shown that surgery for these fractures will allow for a better chance to heal and improved function of the arm. Surgery involves an incision over the collar bone and the placement of a metal plate and screws to secure the broken bones. The risks of surgery include anaesthetic risk, infection, injury to nerves or vessels, failure of fixation, non-union, and malunion.
Often a second operation is required to remove the plate and screws. Many patients report an area of numbness over the chest area after the operation. This numb patch usually diminishes with time.
- The initial pain will usually diminish after one to two weeks, with or without surgery.
- Nonsurgical treatment usually does well for breaks without separation.
- Surgery is considered for fractures with a large amount of separation.
- Treatment for your fracture will depend on many factors, taking into account your individual needs as well as health risks.
- Your surgeon will take into account all of these factors to determine the treatment that will give you the best possible outcome with the minimal risk.
- Remember to ask your surgeon for clarification or elaboration on any of these points