Signs and Symptons
Most clavicle fractures are treated without surgery. The fracture pattern will largely determine whether your surgeon will suggest treating the fracture with or without surgery. Most clavicle fractures occur in the middle third of the bone. These have an excellent chance of healing without surgery. Fractures at the end of the bone near the shoulder are more complicated because of the AC joint and the coracoclavicular ligaments that connect the clavicle to the scapula. Fractures in this area may require surgery. If the fracture is open, meaning there is a laceration that connects with the fracture, surgery is required to cleanse the fracture fragments and reduce the risk of infection.
If your provider makes the assessment that the fracture will heal and give you good shoulder function without surgery, nonsurgical treatment will be recommended. Nonsurgical treatment of clavicle fractures generally requires a sling or a special type of sling called a shoulder immobilizer. The shoulder immobilizer supports the weight of the arm to keep the shoulder girdle and arm from pulling the fracture fragments further out of alignment. You may feel the bone fragments shift as you move; this usually stops by the third week after the fracture. A figure-of-eight clavicle brace may also be suggested. This brace pulls both shoulders back and helps align the fracture fragments.
Some clavicle fractures may need surgery. If your provider makes the assessment that the fracture will NOT heal and give you good shoulder function without surgery, surgical treatment will be recommended. Surgical treatment of clavicle fractures is usually performed two ways: a long metal screw inside the bone or a metal plate and screws along the side of the bone.
Open Reduction and Internal Fixation (ORIF) of clavicle fractures using a metal plate and screws is common. This type of treatment allows the fracture fragments to be restored as close to their normal position as possible and held there until healing occurs. ORIF requires an incision over the area of the fracture. The clavicle is very superficial, meaning that the tissue covering the bone is not much more than the skin. In some thin individuals, the plate can be very prominent.
An intramedullary screw is also sometimes used to treat clavicle fractures. The intramedullary screw is placed inside the hollow medullary canal of the clavicle. The screw can be inserted into the clavicle through a small incision at the shoulder. The screw is inserted with the aid of a special X-ray machine called a fluoroscope. The fluoroscope allows the surgeon to see an X-ray image of the bones on a television monitor and guide the placement of the intramedullary rod by viewing this image.
Infection is possible following any surgical procedure used to treat a fracture, but the risk is very low – less than one in a hundred. The risk is much higher if the fracture is a open fracture. An infection following surgery to repair a fracture may require additional surgery to remove the infected tissue and treatment with antibiotics.
The fracture fragments may fail to heal; this is referred to as a nonunion. The fracture fragments may also heal in an unacceptable alignment; this is called malunion. Both of these complications may result in pain, loss of strength, and a decreased range of motion of the shoulder. A second operation may be needed to treat the complication.
The prognosis for clavicle fractures is generally excellent. The shoulder has the largest range of motion of any joint in the body. What this means if that even if the fracture fragments do not heal exactly in their normal position the shoulder joint can easily compensate and provide you with a well functioning shoulder joint.