Clavicle Fracture Surgery
What Is Clavicle Fracture Surgery?
The clavicle (collarbone) is the S-shaped bone that connects the breastbone to the shoulder blade. Clavicle fracture surgery brings the fracture fragments into alignment and fixes them so that the bone heals in the correct position. Because the large majority of fractures heal without surgery, an operation is performed in selected patients.
For detail on the fracture itself, its types and non-surgical treatment you can review the clavicle fracture page. This page covers the surgical process. For other problems of the shoulder girdle you can review the shoulder page.
Who Is a Candidate, and Who Is Not?
Surgery is not needed for every clavicle fracture. The decision weighs the features of the fracture together with the patient's age, activity level and expectations. Surgery is generally considered in the following situations:
- Comminuted fractures with significant displacement and shortening.
- Fractures at risk of tenting the skin (an open fracture) or carrying a nerve or blood-vessel risk.
- Unstable lateral-end fractures and fractures that do not unite (non-union) or heal in a poor position despite non-surgical treatment.
By contrast, minimally displaced fractures usually heal without surgery with a sling and physiotherapy; surgery is generally not needed in these cases. The decision is made not on the X-ray alone, but by weighing the features of the fracture together with the patient's functional demands.
Preparing for Surgery
Before surgery, an X-ray and, where needed, CT assess the type of fracture, the degree of displacement and the number of fragments; the state of the skin and the nerve and blood-vessel findings are checked. This assessment guides the choice of fixation method.
Blood-thinning medication, smoking and general health are reviewed. Stopping smoking is particularly advised, as it has a favourable effect on union. The risks, the expected benefit and the rehabilitation process are discussed beforehand and the plan is individualised.
How Is the Surgery Performed?
Through an incision over the clavicle the fracture is reached, the fragments are brought into alignment and fixed. The most commonly used method is fixation with a plate and screws; a plate placed on the upper or front surface of the bone holds the fracture securely.
In selected mid-shaft fractures, a nail placed inside the canal of the bone (intramedullary nailing) may be preferred. The choice of method depends on the location of the fracture, the number of fragments and the bone structure. The fixation hardware is usually permanent; it is only considered for removal if it causes discomfort and after the fracture has fully united. Surgery does not shorten the healing time; its aim is a reliable union in correct alignment.
Anaesthesia and Duration
The operation is performed under general anaesthesia, usually with a regional nerve block; the block helps with pain control afterwards. The duration varies with the type of fracture, the number of fragments and the fixation method chosen. Most patients are discharged the same day or after a short hospital stay.
The First Period After Surgery
In the early period the arm is supported in a sling to protect the repair. The duration of the sling and the movements allowed are set according to the type of fracture and the fixation used; forceful movements of the shoulder are avoided early on.
Cold application and the pain medication advised by the doctor are used for pain and swelling. Movement of the elbow, hand and neck is preserved during this period, and the advice on wound care and stitches is followed. X-rays are taken at intervals to monitor union.
Rehabilitation and Return to Sport
Physiotherapy progresses in stages: first protected range of motion, then widening the movement, then strengthening the shoulder girdle and scapular muscles, and finally sport-specific work. The programme is planned according to the patient and the fixation used.
Return to activity and sport is guided by criteria rather than a fixed date: union of the fracture, pain-free movement and adequate muscle strength. An early return to contact sports raises the risk of re-injury before the fixation is strong enough; the decision is therefore made together with signs of union on X-ray and functional tests.
Risks and Factors That Affect the Outcome
The procedure is generally safe; nevertheless, as with any surgery, certain risks are kept in mind: infection, wound-healing problems, non-union or malunion, problems with the fixation hardware (discomfort, loosening), nerve or blood-vessel injury and a change in sensation over the scar.
The outcome is shaped by the type and number of fragments, bone quality, smoking, the suitability of the fixation method and adherence to rehabilitation. Smoking and early forceful loading raise the risk of union problems, so the advice should be followed carefully.
When Should You See a Doctor?
Some symptoms after surgery call for assessment; early attention makes problems easier to manage.
- There is increasing redness, drainage, fever or steadily worsening pain at the wound.
- There is new numbness, weakness or a change in colour in the arm or hand; do not delay.
- Union is not occurring in the expected time, or pain and abnormal sensation with movement persist at the fracture site.
For an assessment of a clavicle fracture and its surgery you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within shoulder surgery.