Site Search:

Question for Physiotherapists

QUESTION | More of my patients with clavicle fractures have had surgery lately. When I first began practice, I don’t remember anyone having surgery on this injury. Is there a new trend favouring surgery on clavicle fractures?

ANSWER | Collar bone or clavicle fractures happen commonly in athletes. The most common site for the bone to break is at the midshaft. Many of these fractures do not shift very far and are treated with a sling with excellent results. When they shift or displace a long way the results of sling treatment are less reliable. These are typically quite high energy injuries such as when a cyclist falls and impacts their shoulder on the ground or from direct trauma such as a rugby tackle. Fractures away from the midshaft generally require surgical treatment and are not the topic of this article.

When a fractured clavicle is not very displaced it generally heals if the patient protects their shoulder with a sling for up to 4 weeks. Shoulder range of motion exercises are commenced as the pain settles, for some patients this is as little as 1-2 weeks post injury.

During my time as an Orthopaedic registrar, even displaced midshaft fractures were treated with a sling and the patient was told that they would be fine. Unfortunately, there were significant numbers of patients that did not achieve a satisfactory outcome in terms of pain, function or cosmesis. One of the better studies on the subject came out of Canada in 2007. This showed better outcomes for patients treated with surgery. There was a lower non-union rate, less shortening of the bone and less shoulder fatigue.

We know that certain groups of patients do not do as well with non-surgical treatment and these patients are generally offered early surgery. This includes when they have a scapula fracture (often referred to as a floating shoulder), if the bone fragments are tenting or putting pressure on the skin and if blood vessels or nerves are injured.

The studies that have followed the Canadian study are somewhat varied in their results. The Canadian study showed up to 15% non-unions 1 year after non-surgical treatment but a Finnish study in 2012 did not show much difference in functional outcomes despite a relatively high non-union rate. What has not been well studied is whether a clavicle that heals in a shortened position affects the shoulder in the long run. There is concern that patients with a shorter shoulder girdle will suffer fatigue related pain of their periscapular muscles with overhead activities.

Across all of the studies the results were good if the fracture healed but the patients returned to work faster if they had surgery. Re-operation rates were relatively high in both groups. In the surgical group many patients wanted the plate removed and in the non-surgical group many patients required surgery for ongoing symptoms. This outcome has been reproduced in several subsequent studies with most showing a small but real benefit with surgical treatment.

As with all things in medicine, treatment must be chosen on an individual patient basis. Careful consideration of the potential harms and benefits are important, as well as the functional desires and needs of the individual patient. If it was my shoulder and I had a displaced midshaft clavicle fracture, I would have the operation.
Dr Doron Sher

If you are a physiotherapist and wish to be sent the Question for Physiotherapists or you would like to submit a Question please email including your name and practice. 

Previous Question for Physiotherapists:

Oct-2017 ACL Grafts  Dr Doron Sher 
Sep-2017  Forefoot pain Dr John Negrine 
Aug-2017 Wrist Ganglion
Dr Kwan Yeoh 
Jul-2017 Anterolateral Ligament Reconstruction  Dr Doron Sher 
Jun-2017  Scapholunate ligament Dr Kwan Yeoh 
Apr-2017  Knee Brace - ACL Reconstruction Dr Doron Sher 
Mar-2017 Sesamoid fractures  Dr Kwan Yeoh 
Feb-2017  Plantar Fasciitis
Dr Todd Gothelf
Nov-2016  Sternoclavicular Joint Dr Doron Sher 
Oct-2016  Proximal Humerus Fractures Dr David Lieu 
Sep-2016 Wrist Fractures  Dr Kwan Yeoh 
Aug-2016  Patella Instability Dr Doron Sher 
Jul-2016 Snowboarders ankle
Dr Todd Gothelf
May-2016  Cortisone Injections Dr Paul Annett 
Apr-2016 Shoulder Instability_1  Dr Ivan Popoff 
Mar-2016 Exercise after TKR  Dr Doron Sher 
Dec-2015 Scaphoid OA Dr Kwan Yeoh 
Nov-2015  Greater Tuberosity Fractures Dr Doron Sher
Oct-2015 Stress Fractures  Dr Paul Annett
Boxers Fractures
Dr Kwan Yeoh
Aug 2015
Resistance Training  Dr John Best
July 2015 LARS Ligament
Dr Ivan Popoff
Distal Biceps  Dr Doron Sher
May-2015 Latarjet procedure
Dr Jerome Goldberg
Apr-2015 TFCC Questions  Dr Kwan Yeoh 
Mar-2015  Acute Ankle Sprains
Dr Todd Gothelf
Nov-2014  PRPP Dr Paul Annett
Oct-2014 Driving After Surgery
Dr Doron Sher
Sep-2014  Distal Biceps Rupture Dr Doron Sher
Aug-2014 Ankle Sprain
Dr Todd Gothelf
Jun-2014  Patella Dislocation Dr Doron Sher
May-2014  Shoulder Instability Dr Todd Gothelf
Apr-2014  De Quervains Dr Kwan Yeoh
Acromio-clavicular joint injuries
Dr Todd Gothelf
Feb-2014 Chronic Knee Pain
Dr Paul Annett
Dec-2013 Foot and Ankle Questions  Dr John Negrine
Oct-2013 Rotator Cuff Repair  Dr Todd Gothelf
Sep-2013  ACL Reconstruction
Dr Doron Sher
Jul-2013 Slipped Upper femoral epiphysis  Dr Rod Pattinson
May-2013 Skiers thumb Dr Kwan Yeoh
Apr-2013  Bakers_Cyst
Dr Ivan Popoff


 Tibial Osteotomy vs UKR

Dr Doron Sher 

 ALIF success rate

Dr Andreas Loefler


 Lisfranc Injuries

Dr Todd Gothelf 

 Anterior Spinal Fusions

Dr Andreas Loefler 

 MCL Injuries

Dr Doron Sher 

Compartment Syndrome

Dr Paul Annett 

 Carpal tunnel

Dr Kwan Yeoh 

 Anterior Process Calcaneus Fx

Dr Todd Gothelf 

 Tenodesis vs Tenotomy

Dr Jerome Goldberg 


 Osteoarthritis in the young active patient Dr Doron Sher 

 Syndesmosis Sprain

Dr Todd Gothelf 


 Triangular Fibrocartilage Injuries

Dr Kwan Yeoh 

 Shoulder Replacement Older Population

Dr Jerome Goldberg



 Wrist Fracture

Dr Kwan Yeoh 



 Adductor Tendon Tear

Dr Paul Annett 

 Navicular Pain 

Dr Todd Gothelf 

 OCD Lesion

Dr Doron Sher 

 Metal on Metal Hip Replacements

Dr Andreas Loefler 

 Femoral Neck Stress Fract (Pt 2)

Dr John Best 


 Femoral Neck Stress Fractures

Dr John Best 

 PCL Injury Part 2

Dr Doron Sher 

 PCL Injury Part 1

Dr Doron Sher 

 Prolotherapy Autologous Blood Injections

Dr Paul Annett 

 Shoulder Impingement

Dr Todd Gothelf 

 Does Chondral Grafting Work

Dr Doron Sher 

 Shoulder Immobilisation-Dislocation

Dr Jerome Goldberg

SLAP Lesions Stable Shoulder

Dr Todd Gothelf 

 Ankle Sprains

 Dr Todd Gothelf


 Dislocation After THR

 Dr Peter Walker


 Acupuncture Muscle Strength Programmes

 Dr Paul Annett


 Full Thickness Rotator Cuff Tears

Dr Jerome Goldberg


 Skiing after TKR

 Prof Warwick Bruce


 Fractures of the Clavicle

 Dr John Trantalis


 Osteoarthritis of the Knee

 Dr Doron Sher


 Fifrth Metatarsal Fractures

 Dr Todd Gothelf


Partial Rotator Cuff Tears

Dr Todd Gothelf

Copyright © 2009 Orthosports
Low Back Pain - Neuroma - Osteotomy

Orthopaedic Surgeon - Knee Reconstruction - ACL tear - Osteotomy
Orthopaedic Surgeon

Enter your email address:
CONCORD 02 9744 2666 | HURSTVILLE 02 9580 6066 | PENRITH 02 4721 7799 | RANDWICK 02 9399 5333 | BELLA VISTA 02 9744 2666
Copyright © 2009 Orthosports