Collarbone Fractures (Clavicle Fractures): Treatment Options

Collarbone Fractures (Clavicle Fractures): Treatment Options

Clavicle or collarbone fractures can be treated with or without surgery. It is important for the doctor to note the location and type of fracture that a patient has before determining if surgery is needed. Most nondisplaced fractures of the clavicle do not require surgery, as the bony ends are likely to heal back together.

Even in cases where the bony ends may have moved a little or even become angled, surgery might not be needed, and the patient will be able to return to regular activity. If it is determined that the patient will not have surgery, they will be immobilized with a sling or figure-of-eight strap for a few weeks so the bones can start to heal. Physical therapy will likely be recommended to help regain motion and strength.

Fractures that have multiple bony pieces may require surgery, as the bony ends are less likely to fully heal back together. If a fracture is displaced significantly more than 2 cm, or occurs in a Z pattern, surgery will be strongly considered. If no surgery is done in this setting, patients may have slower or incomplete healing and decreased function in the arm. Also, patients may have concerns about how the fracture looks cosmetically if it is not reduced with surgery.

Surgery is always recommended for fractures that break through the skin, compromise surrounding skin, injure a nearby vessel or nerve, or if patients have other injuries in the shoulder. Several factors are considered when deciding if treatment should be with or without surgery. For example, the general overall health and activity level of the patient will be assessed along with their injury to make the final decision.

If surgery is chosen, there are several methods that can be used depending on location and displacement of the fracture and on surgeon preference. On the day of surgery, the patient will be placed flat on their back or with their head and torso slightly elevated, also referred to as the beach chair position. Surgeons will use x-rays throughout surgery to ensure that the implants are in the best location and the fracture is reduced.

An incision will be made over the fracture site. Most commonly in a midshaft fracture, use of a metal plate and screws will be chosen for repair. With this method, a patient's fracture is quickly stabilized to allow for early healing. For a distal fracture at the end of the clavicle, the surgeon may use a suture-based implant along with a metal plate and screws to fix the broken bone and to bring it back to connect to the shoulder blade. Some surgeons may use an arthroscope, or camera, to view the necessary structures for this type of repair.

In either surgery, the incisions will be carefully closed and a dressing will be placed over the skin. Following surgery, the patient will be immobilized in a sling to allow for the incision and bones to heal. The surgeon will get x-rays done at follow-up visits to make sure the bones are healing and that they have not moved out of place. Physical therapy will be recommended to help regain motion and strength. A clavicle fracture will typically heal in 6 to 12 weeks. However, several more weeks may be required for rehabilitation to return to normal motion and strength.