Fractures of the clavicle (collar bone) are very common injuries. The treatment of clavicle fractures consists of either conservative non operative treatment using a sling, or early operative treatment and plating of the clavicle fracture. There is evidence in the orthopaedic literature that wide separation of fractures ends or marked shortening or overlap of the clavicle fracture may well be associated with either a delayed union or a symptomatic non union of the collar bone. There is recently some evidence to suggest that earlier internal fixation or plating of collar bone fractures produces a better result than delayed or late reconstruction. If the collar bone is markedly shortened through an overlap of the bone ends then there is a possibility of reduced shoulder function in the longer term. If your collar bone fracture is displaced then surgery may be suggested as the best form of treatment to enable you to return to normal activities and sporting activities within the shortest possible time frame.
Displaced clavicle fracture
Reconstructed clavicle fracture
Surgery for clavicle fractures involves an overnight stay in hospital and general anaesthetic which will last for approximately one hour. The ends of the collar bone fracture are exposed through a wound which is approximately 12-14cm long. The ends of the fractured bone are re-opposed and plated with a contoured titanium plate which is very thin and strong. Usually 6 or 8 screws are used to fix the plate on to the collar bone. Usually this produces very strong fixation on the bone and a sling is only required for several days following the procedure. At the end of the operation a large amount of local anaesthetic is injected around the wound. A nerve block may also be administered to your shoulder and you will be provided with an ice pack for your shoulder to reduce the swelling around the wound and reduce your pain levels. You may take the ice pack home with you after surgery and use it for as long as you wish thereafter.
Following surgery there will be an area of permanent numbness around the scar over your shoulder. This will be variable in size from patient to patient, but in time the size of the numb area may decrease but there will be permanent numbness of some description. This is unavoidable as nerves supplying the skin have to be divided in order to access the fracture. The specific potential complications of clavicle fixation include the risk of infection and if this is severe it may necessitate admission to hospital for intravenous antibiotics. There is risk to the nerves and vessels which are directly below the collar bone. There is a risk of collar bone non union and there is a small risk of developing a frozen shoulder following this procedure but the risk of complications is low. You will usually be discharged on the day following surgery if comfortable after review of your post operative x-rays, and commence physiotherapy within one or two days of the surgery working towards a full range of movement in the first instance.
By approximately 10 days your wound should be healed and you should be able to engage in light training activities in the gym and swimming. You will be able to run at that stage, cycle and play golf. If your collar bone fracture is relatively simple in nature and good fixation of the bone is achieved at the time of surgery, then it would be reasonable for you to return to training activities without taking contact at approximately 4 weeks from surgery. You should be able to return to driving a car within two weeks of surgery. If your collar bone fracture occurred some time before surgery and the fracture has not united, you may also require the use of synthetic bone graft to facilitate healing of your fracture. If you smoke following surgery this will reduce the likelihood of the collar bone healing. A good or excellent result is to be expected in the vast majority of patients undergoing surgery for this condition.
For fractures of the outer end of the collar bone or those sustaining a dislocation of the acromioclavicular joint or outer end of the collar bone involves the use of a hook plate which is used to hold the ends of the collar bone in place by hooking a portion of the plate underneath the acromion bone. This invariably means that the tendons below the acromion will be nipped by the presence of the plate and the plate has to be removed between 3 and 6 months following surgery.