What is a Clavicle Fracture?
The break or fracture of the clavicle (collarbone) is a common sports injury associated with contact sports such as football, martial arts, as well as other unexpected falls onto your shoulder. A direct blow over the shoulder that may occur during a fall on an outstretched arm or a motor vehicle accident may cause the clavicle bone to break.
Symptoms of Clavicle Fractures
A broken clavicle may cause difficulty in lifting your arm because of pain, swelling and bruising over the bone.
Indications for Clavicle Fracture Surgery
A broken clavicle bone usually heals without surgery, however if the bone ends have shifted out of place (displaced), surgery may be recommended. Surgery for the fixation of clavicle fractures may be considered in the following circumstances:
- Multiple fractures of the same or different extremity/side.
- Compound (open) fractures
- Fractures associated with nerve or blood vessel damage
- Scapula fracture
- Overlapping of the broken ends of the bone (shortened clavicle)
Treatments for Clavicle Fractures
Surgery is performed to align the bone ends and hold them stable during healing. This improves shoulder strength, in particular with overhead activities. Some examples of the surgical options are listed below:
Plates and Screws Fixation
During this surgical procedure, your surgeon will reposition the broken bone ends into normal position and then uses special screws or metal plates to hold the bone fragments in place. These plates and screws are usually left in the bone but can be removed after fracture healing is complete if they cause any irritation. Often Dr. Southard will utilize a lower profile 90/90 degree plating option that decreases the need for further surgical intervention down the road, including removal of hardware.
Pins
The placement of pins may also be considered to hold the fracture in position. They often cause irritation in the skin at the site of insertion and must be removed once the fracture heals. This option, while available is used far less often.
Percutaneous Elastic Intramedullary Nailing of the Clavicle
Similarly to percutaneous pins, this procedure is often described as a less invasive procedure with fewer complications. While considered a safe method for fixation of displaced clavicle fractures in adolescents and athletes that allows for rapid healing and faster return to sports, it also has it’s limitations. The procedure is performed under fluoroscopic (x-Ray) guidance. It involves a smaller, usually < 1 cm skin incision medial to the fracture site. A hole is then drilled in the anterior cortex and an elastic nail is inserted into the medullary canal of the clavicle. The nail is then passed on to reach the fracture site. A second operation to remove the nail will be performed after 2-3 months.
https://pubmed.ncbi.nlm.nih.gov/26377733/
Complications of Clavicle Fracture Surgery
You are at a greater risk of complications during and after clavicle fracture surgery if you have diabetes, are elderly and use tobacco products. In addition to the risks that occur with any major surgery, certain specific risks of clavicle fracture surgery include difficulty in bone healing, lung injury, and irritation caused by hardware. Many patients, regardless of the procedure chosen ultimately have to undergo a second procedure to remove painful and symptomatic hardware.
