What are the common causes of clavicle fractures. How are clavicle fractures diagnosed and treated. What is the typical recovery time for a broken collarbone. What factors influence clavicle fracture healing.

Understanding Clavicle Fractures: Anatomy and Prevalence

Clavicle fractures, also known as broken collarbones, are among the most common bone injuries, accounting for up to 10% of all fractures. The clavicle is an S-shaped bone that connects the upper extremity to the trunk, articulating with the acromion at the acromioclavicular joint and the sternum at the sternoclavicular joint.

The clavicle’s superficial location and exposure to various forces make it susceptible to fractures. Approximately 1 in 1000 people experience a clavicle fracture each year, with a higher prevalence in males. The injury shows a bimodal age distribution, peaking in young men under 25 (often due to sports injuries) and individuals over 55 (typically from falls).

Fracture Location Statistics

• Middle third (midshaft): 69% of cases
• Distal third: 28% of cases
• Proximal third: 3% of cases

In children, the middle third accounts for 95% of clavicle fractures. Interestingly, clavicle fractures represent 95% of fractures seen during childbirth.

Causes and Mechanisms of Clavicle Fractures

Understanding the causes of clavicle fractures is crucial for prevention and proper treatment. What are the primary mechanisms leading to a broken collarbone? The most common cause, accounting for 87% of reported cases, is a fall directly onto the lateral shoulder. Other causes include:

• Direct trauma to the clavicle
• Fall onto an outstretched hand
• High-impact sports injuries
• Motor vehicle accidents

The midshaft of the clavicle, being the thinnest segment and lacking ligamentous attachments, is particularly vulnerable to fractures. This explains why middle third fractures are the most frequent type of clavicle injury.

Diagnostic Approaches for Clavicle Fractures

Proper diagnosis is essential for effective treatment of clavicle fractures. How do medical professionals diagnose a broken collarbone? The diagnostic process typically involves:

1. Physical examination: Assessing pain, swelling, and deformity
2. Patient history: Understanding the mechanism of injury
3. Imaging studies: Primarily X-rays to confirm the diagnosis and determine fracture type

X-rays are the gold standard for diagnosing clavicle fractures. They help visualize the fracture pattern, displacement, and any comminution. In some cases, CT scans may be used for more detailed assessment, especially in complex fractures or when surgical intervention is being considered.

Classification Systems for Clavicle Fractures

Clavicle fractures are typically classified using established systems to guide treatment decisions. What are the main classification systems used for clavicle fractures? The two primary systems are:

Allman Classification System

This system divides clavicle fractures into three groups based on location:

• Group I: Middle third or midshaft fractures (most common)
• Group II: Distal or lateral third fractures
• Group III: Proximal or medial third fractures

Neer Classification System

Neer further refined the Allman classification, particularly for distal clavicle fractures:

• Type 1: Minimal displacement, lateral to intact coracoclavicular ligament
• Type 2: Medial fragment separated from coracoclavicular complex, often with significant displacement
• Type 3: Non-displaced fracture extending into the acromioclavicular joint

These classification systems help guide treatment decisions and predict outcomes for different types of clavicle fractures.

Treatment Options for Clavicle Fractures

The treatment of clavicle fractures depends on various factors, including fracture location, displacement, and patient characteristics. What are the main treatment approaches for clavicle fractures?

Conservative Management

Most clavicle fractures can be treated non-surgically, especially those that are minimally displaced. Conservative treatment typically involves:

• Pain management with analgesics
• Immobilization using a sling or figure-of-eight bandage
• Gradual return to activities as pain subsides
• Physical therapy to restore range of motion and strength

Surgical Intervention

Surgery may be recommended for certain types of clavicle fractures, including:

• Severely displaced fractures
• Comminuted fractures
• Open fractures
• Fractures with neurovascular compromise
• Fractures in high-performance athletes

Surgical options include open reduction and internal fixation (ORIF) using plates and screws or intramedullary fixation with pins or rods. The choice of surgical technique depends on the fracture pattern and surgeon preference.

Recovery Time and Healing Process for Clavicle Fractures

The healing time for clavicle fractures can vary significantly depending on several factors. What is the typical recovery timeline for a broken collarbone? While individual cases may differ, a general timeline includes:

• Initial healing: 4-6 weeks for bone callus formation
• Complete healing: 3-6 months for full bone remodeling
• Return to normal activities: 6-12 weeks, depending on the fracture severity and treatment approach

Factors influencing healing time include:

1. Patient age: Younger patients typically heal faster
2. Fracture location and severity
3. Treatment method (conservative vs. surgical)
4. Patient compliance with treatment recommendations
5. Overall health and nutrition status

It’s important to note that while pain may subside relatively quickly, complete bone healing takes longer. Patients should follow their healthcare provider’s guidance regarding activity restrictions to ensure optimal healing.

Complications and Long-Term Outcomes of Clavicle Fractures

While most clavicle fractures heal without significant complications, some patients may experience issues during or after the healing process. What are the potential complications of clavicle fractures?

Common Complications

• Nonunion: Failure of the bone to heal properly
• Malunion: Healing in a non-anatomical position, potentially causing functional issues
• Shoulder stiffness or weakness
• Persistent pain or discomfort
• Neurovascular complications (rare)

Long-Term Outcomes

The majority of patients with clavicle fractures experience good long-term outcomes, especially with appropriate treatment. However, some factors may influence long-term results:

• Fracture type and severity
• Treatment method chosen
• Patient age and overall health
• Compliance with rehabilitation protocols

Patients who undergo surgical fixation may have a faster return to function but may also face risks associated with surgery, such as infection or hardware-related issues.

Prevention Strategies for Clavicle Fractures

While not all clavicle fractures can be prevented, certain measures can reduce the risk of injury. What steps can individuals take to minimize the likelihood of a clavicle fracture?

1. Use proper protective equipment in sports: Wear appropriate padding and gear, especially in contact sports.
2. Practice fall prevention: This is particularly important for older adults. Improve home safety and engage in balance exercises.
3. Strengthen shoulder and upper body muscles: This can provide better support and stability to the clavicle region.
4. Maintain bone health: Ensure adequate calcium and vitamin D intake, especially in at-risk populations.
5. Use proper technique in sports and activities: Learn and practice correct form to reduce injury risk.

By implementing these preventive strategies, individuals can reduce their risk of experiencing a clavicle fracture, particularly in high-risk activities or populations.

Rehabilitation and Return to Activity After Clavicle Fracture

Proper rehabilitation is crucial for optimal recovery and return to normal activities following a clavicle fracture. What does the rehabilitation process typically involve?

Phases of Rehabilitation

1. Initial phase (0-4 weeks):
   • Pain management and protection of the fracture site
   • Gentle pendulum exercises to maintain shoulder mobility
   • Wrist and elbow exercises to prevent stiffness
2. Intermediate phase (4-8 weeks):
   • Gradual increase in range of motion exercises
   • Introduction of light strengthening exercises
   • Focus on scapular stabilization
3. Advanced phase (8-12 weeks and beyond):
   • Progressive strengthening of shoulder and upper body muscles
   • Sport-specific or activity-specific training
   • Gradual return to normal activities and sports

Return to Activity Guidelines

The timeline for returning to specific activities varies based on the individual case. General guidelines include:

• Desk work: Often possible within 1-2 weeks
• Driving: Usually safe once out of the sling and with adequate range of motion (typically 4-6 weeks)
• Light physical activities: May begin around 6-8 weeks
• Contact sports or heavy lifting: Often restricted for 3-6 months

It’s crucial to follow the guidance of healthcare providers and physical therapists during the rehabilitation process. Returning to activities too soon can risk re-injury or complications.

Special Considerations for Clavicle Fractures in Different Populations

Clavicle fractures can affect various populations differently, requiring tailored approaches to management and treatment. How do clavicle fractures differ in specific groups?

Pediatric Clavicle Fractures

Clavicle fractures in children have unique characteristics:

• Higher healing potential due to active growth plates
• Often managed conservatively with excellent outcomes
• Risk of growth disturbances in severe cases
• Need for close monitoring to ensure proper alignment during healing

Clavicle Fractures in Athletes

Athletes may require special considerations:

• Pressure to return to sport quickly
• Higher likelihood of surgical intervention to expedite return to play
• Need for sport-specific rehabilitation protocols
• Importance of protective equipment upon return to contact sports

Clavicle Fractures in Older Adults

Elderly patients with clavicle fractures may face additional challenges:

• Increased risk of complications due to osteoporosis
• Longer healing times
• Need for careful pain management and fall prevention strategies
• Consideration of nutritional support to promote healing

Understanding these population-specific factors helps healthcare providers tailor treatment plans and set appropriate expectations for recovery.

Emerging Trends and Future Directions in Clavicle Fracture Management

The field of clavicle fracture management continues to evolve, with ongoing research and technological advancements. What are some emerging trends and potential future directions in this area?

Minimally Invasive Surgical Techniques

Researchers are exploring less invasive surgical approaches, including:

• Arthroscopic-assisted fixation techniques
• Percutaneous pinning methods
• Novel intramedullary devices

These techniques aim to reduce surgical trauma and potentially improve recovery times.

Biological Augmentation

Emerging research is investigating ways to enhance bone healing, such as:

• Use of bone morphogenetic proteins (BMPs)
• Platelet-rich plasma (PRP) injections
• Stem cell therapies

These biological approaches may help accelerate healing, particularly in complex cases or patients with compromised healing capacity.

Advanced Imaging and 3D Printing

Technological advancements are improving preoperative planning and implant design:

• 3D-printed patient-specific implants
• Virtual surgical planning using advanced CT imaging
• Augmented reality-assisted surgical navigation

These technologies may lead to more precise and personalized treatment approaches.

Outcomes Research

Ongoing studies are focusing on refining treatment algorithms and improving long-term outcomes:

• Comparative studies of conservative vs. surgical management
• Investigation of factors predicting nonunion or malunion
• Development of more sophisticated classification systems to guide treatment decisions

As research in these areas progresses, it is likely that the management of clavicle fractures will become increasingly tailored to individual patient needs, potentially leading to improved outcomes and faster recovery times.

Clavicle Fractures – StatPearls – NCBI Bookshelf

Continuing Education Activity

Fractures of the clavicle are quite common, accounting for up to 10% of all fractures. It is the most common fracture of childhood. A fall onto the lateral shoulder most frequently causes a clavicle fracture. Radiographs confirm the diagnosis and aid in further evaluation and treatment. While most clavicle fractures are treated conservatively, severely displaced or comminuted fractures may require surgical fixation. This activity reviews the etiology, presentation, evaluation, and management of clavicular fractures and reviews the role of the interprofessional team in evaluating, diagnosing, and managing the condition.

Objectives:

• Describe the various mechanisms of injury that can result in clavicle fractures, including the prevalence in the bimodal age distribution of these injuries.

• Summarize the components of proper evaluation and assessment of a patient presenting with a potential clavicle fracture, including any indicated imaging studies.

• Review the treatment and management options available for clavicle fractures, based on the specific fracture type, location, and patient characteristics.

• Discuss how an optimally functioning interprofessional team would coordinate care to enhance outcomes for patients with arthritis of the facet joints.

Access free multiple choice questions on this topic.

Introduction

Fractures of the clavicle are quite common, accounting for up to 10% of all fractures[1]. It is the most common fracture of childhood. A fall onto the lateral shoulder most frequently causes a clavicle fracture. Radiographs confirm the diagnosis and aid in further evaluation and treatment. While most clavicle fractures are treated conservatively, severely displaced or comminuted fractures may require surgical fixation.

Etiology

In 87% of reported cases, a clavicle fracture results from a fall directly onto the lateral shoulder. Less commonly, fractures may result from direct trauma to the clavicle or from a fall onto an outstretched hand.

Epidemiology

Clavicle fractures represent 2% to 10% of all fractures. Clavicle fractures affect 1 in 1000 people per year. They are the most common fractures during childhood, and approximately two-thirds of all clavicle fractures occurring in males. There is a bimodal distribution of clavicle fractures, with the 2 peaks being men younger than 25 (sports injuries) and patients older than 55 years of age (falls).[2] Aapproximately 20 percent of females and more than one-third of males with claviclular fractures are between 13-20 years old.[3]

The middle third of the clavicle is fractured in 69% of cases, the distal third is fractured in 28% of cases, and the proximal third is fractured in 3% of cases.[3]

• The middle third of the clavicle represents 95% of fractures seen in children. In children younger than 10, these are frequently nondisplaced, while in children older than 10 the majority are displaced. Clavicle fractures represent 95% of fractures seen during childbirth. [4], [5], [6]

Pathophysiology

The clavicle is an S-shaped bone and is the only osseous link between the upper extremity and the trunk. The clavicle articulates distally with the acromion at the acromioclavicular joint and articulates proximally with the sternum at the sternoclavicular joint. Due to its superficial subcutaneous location and the numerous ligamentous and muscular forces applied to it, the clavicle is easily fractured. Because the midshaft of the clavicle is the thinnest segment and does not contain ligamentous attachments, it is the most easily fractured location.

Fractures of the clavicle are typically described using the Allman classification system, dividing the clavicle into 3 groups based on location. Fractures of the middle third or midshaft fractures are in Group I (the most common), fractures of the distal or lateral third are in Group II, and fractures of the proximal or medial third are in Group III.[7]

The Allman classification has been further revised by Neer and includes the following:[8]

• Type 1 fracture where there is minimal displacement. These fractures occur just lateral to the intact coracoclavicular ligament and are managed non-surgically.

• Type 2 fracture occurs when the medial fragment is separated from the coracoclavicular complex. The fragment is displaced inferiorly due to the pull of the sternocleidomastoid muscle. The distal fragment is displaced cranially. This fracture results in an obvious deformity and has a high rate of nonunion.

• Type 3 fracture is where there is non-displacement of the fracture but it extends into the acromioclavicular joint. Again, these fractures are treated non-surgically. However, late AC degenerative changes can occur and may require excision of the distal clavicular segment.

Many important structures are adjacent to the clavicle and thus subject to injury when a fracture occurs. The subclavian artery passes anterior to the first rib and is in close proximity with the middle segment of the clavicle. In addition, the brachial plexus also course behind the clavicle and are at risk when there is a fracture of the middle clavicle.

More than 85 percent of clavicular fractures occur by a fall onto the shoulder[9]. Most of these fractures among the young  occur in a traffic accident or a sports injury[3]. Approximately 40 percent of injuries caused by traffic accidents occur in cyclists, more than 25 percent in car drivers or passengers, 17 percent in motorcyclists, and 17 percent in pedestrians[3]. There seems to be no correlation between the clavicular fracture site and the mechanism of injury[9]. Clavicle fractures do occur in isolation but when there is a high energy injury one should always look for associated injuries like a pneumothorax, hemothorax, and head trauma.

History and Physical

Patients with clavicle fractures typically present with well-localized pain over the fracture site. The affected extremity is typically held close to the body. Patients may report a snapping or cracking sound when the injury occurs. The most common reported mechanism is a fall onto the lateral shoulder. A direct blow to the clavicle or a fall on an outstretched hand are less common mechanisms.

On physical examination, the patient may present with a visible or palpable deformity over the fracture site. The shoulder is typically pulled downward in patients with fractures of the middle third of the clavicle, due to the effect of the pectoralis major and latissimus dorsi muscles on the distal fragment. The sternocleidomastoid displaces the proximal fragment upward. There may be localized tenderness, crepitus, ecchymoses, or edema over the clavicle. Severe angulation or displacement of the fracture may result in the tenting of the skin, which signifies a high risk for it to develop into an open fracture.

Because of the proximity of the brachial plexus and subclavian vessels to the clavicle, it is important to perform a complete neurovascular examination. Decreased distal pulses, discoloration, or edema may be present in a subclavian vessel injury. Brachial plexus injury may result in distal neurologic findings. A complete lung examination should also be performed, as rarely there may be an injury to the lung apex, resulting in pneumothorax or hemothorax. Shortness of breath or diminished breath sounds may be a clinical clue. Palpation of the surrounding ribs and scapula should be performed to evaluate for possible associated rib or scapular fractures.

Repetitive stress on proximal clavicle from different activities may lead to a stress fracture in patients with no history of acute trauma.[10], [11], [12]

Evaluation

A standard anteroposterior clavicle radiograph should be obtained in all patients who present with an injury to the clavicle. A second 45-degree cephalic tilt view radiograph improves the assessment of the degree of clavicle displacement. This additional view also minimizes the overlap of the first rib and scapula. While most clavicle fractures are visible using these views, a CT scan may be necessary to guide treatment in the less frequent proximal or distal fractures to evaluate intra-articular involvement.[13] An expiratory posteroanterior chest radiograph should be obtained if there is a clinical concern for possible pneumothorax or rib injury. If there is a concern for neurovascular injury, arteriography, ultrasonography, and CT may be used to guide further management.

Evaluation of the proximal clavicular stress fractures begins with plain radiographic views and a CT scan when necessary. Further imaging may be required to rule out inflammation and neoplasia in patients with radiographic and clinical evidence of swelling around this area.

Treatment / Management

Immediate orthopedic consultation should be obtained for patients with neurovascular compromise, open fractures, tenting of the skin, severe angulation or displacement or any break in the skin near the fracture, which are absolute indications for surgery. Relative surgery indications include Neer Type II displaced distal-third fractures, fracture-shortening above 1.5 cm, or 15% of the contralateral side, floating shoulder, polytrauma, significant seizure or neuromuscular disorder, and cosmetic issues due to displacement.[14], [15], [16] After a complete evaluation of possible associated injuries and ruling out indications for surgery, the mainstay of treatment of clavicle fractures is analgesia, immobilization, and proper orthopedic follow-up.

In group I midshaft clavicle fractures, conservative nonoperative management is the most common approach. Treatment of these fractures consists of supportive or reductive measures. Supportive treatment involves the placement of a sling or sling and swathe, while reductive treatment includes the use of a figure-of-eight brace. Similar union rates have been achieved using either method. In uncomplicated nondisplaced midshaft fractures, patients treated nonoperatively with these conservative measures have fewer complications and a faster recovery then those treated operatively. However, in patients with a higher risk of nonunion (due to fracture displacement, clavicle shortening, or fracture comminution) surgical fixation results in improved patient outcomes relative to nonoperative management. Surgical fixation is achieved with open reduction with plate fixation or intramedullary fixation.[17]

In group II distal clavicle fractures, patients should be immobilized with a simple sling or sling and swathe. Figure-of-eight braces should be avoided, as they may increase the displacement of the fracture. Because nonunion is seen in approximately 30% of cases, an orthopedic referral is necessary. Definitive treatment is controversial, with some studies showing improved outcomes with surgical fixation while others show similar outcomes in patients managed nonoperatively.

Nondisplaced, proximal, group III clavicle fractures are treated conservatively, with a sling used for support and comfort. Analgesics and early range of motion are encouraged. Significantly displaced proximal clavicle fractures are rare secondary to strong ligamentous support. Serious associated injuries are found in approximately 90% of displaced proximal clavicle fractures. If signs of neurovascular compromise exist, displaced proximal fractures should be immediately reduced. These patients should carefully be evaluated for severe intrathoracic injury.[18]

Treatment for children is similar to adults. Because of the great periosteal regeneration potential in children, healing occurs more quickly than in adults. Callus formation can be prominent in children, and parents should be educated on this normal finding.

Differential Diagnosis

The differential diagnosis of a clavicle fracture includes acromioclavicular joint injury, rib fracture, scapular fracture, shoulder dislocation, rotator cuff injury, and sternoclavicular joint injury. Possible complications of clavicle fractures must also be fully evaluated, including pneumothorax, brachial plexus injury, and subclavian vessel injury. An inflammatory or neoplastic process could mimic a clavicular stress fracture.

Prognosis

The prognosis of the majority of clavicle fractures is good. Most clavicle fractures are treated conservatively and nonoperatively. Patients are immobilized in a sling or figure-of-eight brace until the clinical union is achieved. This typically occurs by 6 to 12 weeks in adults and 3 to 6 weeks in children. Patients should perform a range of motion and strengthen exercises under the care of physical therapy once immobilization is no longer necessary. Patients typically may resume full daily activity approximately 6 weeks after injury. Requiring 2 to 4 months of rehabilitation, return to full contact sports requires the athlete should demonstrate radiographic evidence of bony healing, no tenderness to palpation, a full range of motion, and normal shoulder strength.

Complications

In fractures of the clavicle, serious complications are rare. Brachial plexus injury or injury to the subclavian vessels can occur at the time of presentation or during the healing and callus formation of the clavicle. Excessive callus formation can lead to compression of the brachial plexus, resulting in peripheral neuropathy.

The most common complication of clavicle fractures is malunion, or when the clavicle fracture heals with angulation, shortening, or a poor cosmetic appearance. Patients with malunion of clavicle fractures typically have except full function and are clinically not significant. Some malunions may cause neurologic or functional problems, especially if there is a shortening greater than 2 cm. [19] In patients with continued pain, decreased range of motion, or decreased strength secondary to the malunion, delayed surgical correction may be considered.

Nonunion is the failure of the fracture to heal in 4 to 6 months. In middle-third clavicle fractures, the nonunion rate for all fractures treated nonoperatively is 6%, increasing to 15% in displaced fractures. Nonunion rates for distal third clavicle fractures range from 28% to 44%. Risk factors for nonunion include advanced age, female gender, smoking, significant displacement or shortening of fracture, fracture comminution, and inadequate immobilization. Many patients with clavicle fracture nonunion are asymptomatic and do not require any further treatment. Other symptomatic clavicle fracture nonunion patients may have continued pain, loss of range of motion, or loss of function. These patients should be referred to an orthopedic surgeon for further surgical management.[20]

Proximal-third clavicle fracture complications include nonunion and posttraumatic arthritis. Acutely, proximal clavicle fractures displaced inwardly may result in severe intrathoracic injuries, including brachial plexus injury, subclavian vessel injury, and pneumothorax.[21] Fractures of the distal third of the clavicle have the highest incidence of nonunion; however, many of these patient’s nonunions are asymptomatic.[22] Degenerative arthritis within the acromioclavicular joint can be a late complication.

Enhancing Healthcare Team Outcomes

Patients with clavicular fractures are best managed by an interprofessional team that includes an orthopedic surgeon, emergency department physician, primary care provider, nurse practitioner, and a physical therapist. Most patients with clavicular fracture first present to the emergency department and it is important to consult with the radiologist for the appropriate imaging studies. A thorough neurovascular and lung exam is necessary. The majority of clavicular fractures are managed with conservative care.[23][24] However, immediate orthopedic consultation should be obtained for patients with neurovascular compromise, open fractures, tenting of the skin, or any break in the skin near the fracture. [25][26]

The orthopedic nurse should inform the patient that a visible prominence may be present for months and it is a normal part of healing. If the patient continues to have pain and difficulty with motion, then nonunion should be suspected. The patient should be educated that return to sports should only take place after complete healing has occurred. The healing of the fracture may take 8-12 weeks and most patients have a good outcome. However, a few patients may have chronic pain and limited range of motion of the shoulder.

Review Questions

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Figure

clavicle fracture after a fall from a ladder. Image courtesy S Bhimji MD

Figure

Clavicle fracture. Image courtesy O.Chaigasame

Figure

CXR demonstrating right clavicle fracture, elevated right hemi-diaphragm associated with phrenic nerve injury. Contributed by Zhongyu Li, MD PhD

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Disclosure: Thomas Bentley declares no relevant financial relationships with ineligible companies.

Disclosure: Shayan Hosseinzadeh declares no relevant financial relationships with ineligible companies.

Clavicle fracture

What is a clavicle fracture?

The clavicle is also known as the collar bone.  It is a strut between the sternum and the shoulder blade.  It is the pivot which the shoulder blade moves around, keeping the shoulder out to the side of the body.

What is the non operative treatment?

Because the clavicle has a complex movement and is surrounded by muscle, it cannot be immobilized in a plaster cast in the usual way.  The normal treatment for a broken clavicle is simply to keep the arm in a sling.  90% of all fractures heal well with this treatment.

How long does it take to heal?

The time a clavicle fracture takes to heal is variable; affected by age, health, type and location of the break.  Adult fractures typically take a minimum of 3-4 weeks of sling immobilization to allow the bone and soft tissue to heal. It will be 6 weeks before returning to manual work or sports.  Children take less time and can often achieve the same healing in only two weeks.

During this period, patients should remove the sling to perform pendulum exercises to minimize stiffness and keep the shoulder muscles active.  Activities can be increased as pain allows; if you are doing something which is making it hurt- you should stop, on the other hand if all is well- activities can be increased.

In some cases the fracture does not heal.  In most cases you surgeon will be able to predict which fractures are likely not to heal (see below). However rarely some simple fractures do not heal.  This is called a non-union and when painful will require surgery.

What is the operative treatment?

The surgery may be necessary when there is;

• Multiple fragments of bone with gaps between them.
• Shortening of the clavicle when the fractured ends overlap by more than 2cm.
• If the broken bone has, or is at risk of coming out through the skin.
• Non Union (hasn’t healed) after 3-6 months
• Fractures at the distal end of the bone (near to the shoulder) which can interfere with Acriomio Clavicular Joint of the shoulder.

The operation is through an 8 -12cm ‘bra strap’ incision which goes from front to back of the shoulder.  This incision gives the best scar.  The fracture is reduced by putting the bone ends back together.  They are held in place by an 8 cm plate and some screws.   The skin is then closed over the top with absorbable sutures. 

If the surgery is to treat a non union, bone graft may be taken from the hip.  The bone in the Iliac crest (which is the bone you can feel at your side below the waist) has lots of bone healing cells in it, when placed in the fracture site it helps the non-union to heal.  Only a 1cm chunk of bone is removed from the hip, however the operation site is reported as being very painful for a few weeks.  The wound and dressings should be treated in the same way as the shoulder wound (see below).

What should I expect after the operation?

The anaesthetist will have used an anaesthetic block to make the arm numb during surgery and the immediate post operative period.  Once the numbness has worn off (4-8 hours) the shoulder will become painful and you will be given regular pain killers as soon as you get back to the ward.  Even though you may be pain free at rest you must take the tablets for when you move the shoulder as part of your rehabilitation program.    A combination of regular painkillers such as paracetamol or codeine should be taken with NSAIDs (unless contra-indicated) such as ibuprofen- which is also an anti inflammatory drug.  If the pain killers you have been given are not sufficient please contact your consultant’s secretary or your GP.   

The procedure is an open operation through a 8-12 cm incision and is closed with a dissolving stitch.  This heals well, usually leaving a faint scar.  The dressing should remain on for 10- 14 days, kept clean and dry until it is removed at your follow up appointment.  If you have any concerns about the wound you should contact your surgeon’s secretary or your GP practice nurse. 

You will be given a sling which will protect your shoulder and should be worn for a minimum of 3 weeks.  You will need a dedicated physiotherapy program after your surgery.  If you have been seeing a physiotherapist prior to your surgery (who may have referred you to Guildford Upper Limb), you should arrange to see them afterwards so you can start your rehabilitation straight away.   If you do not have a physiotherapist we can arrange for you to be seen before you go home after the operation.

After surgery, full union is seen on x-rays typically at 12 weeks for adult patients, and shorter times are achieved by children. In patients who work at the physiotherapy, 85-100% mobility returns in 6-9 months, with full strength returning in 9-12 months.  Return to driving and office work at 3 weeks, manual work will take 12 weeks.

Is there anything that can go wrong?

Operations to fix the clavicle are very successful and most people who have them are delighted with the operation and are glad they had it done. Like any operation a very small number of people can have a problem. The main problem is non union and failure of the plate and screws.  If the bone does not heal the screws will always pull out of the bone because they fatigue with repetitive movement. Some patients experience a patch of numb skin below the operation site which is unpleasant.  Nerves can be bruised and the shoulder can become stiff.   In thin patients the plate can be visible under the skin and cause irritation when wearing a seat belt or rucksack, the plate can be removed at 1 year but is not routinely recommended. The risks of these problems only add up to 3-5% of all operations but need to be taken into account when deciding whether to have the operation. You should discuss the possibility of problems with your surgeon before your operation.

How to accelerate the fusion of bones after a fracture?

How to accelerate bone healing after a fracture?

When it comes time to heal a broken bone, our body usually knows what to do. But in some cases, fractures heal very slowly or do not show signs of healing at all for a certain time. However, the process of bone healing after a fracture can be accelerated by following certain recommendations.

The healing process of a broken bone

Before getting into the recommendations, let’s look at the process of repairing a broken bone.

Stage 1: Inflammation

When a bone breaks, the body sends white blood cells to the fracture site to remove foreign matter from the blood. This causes inflammation, which stimulates the growth of new blood cells and is the first step in recovery.

Step 2: soft callus

In the next step, your body creates a callus around the fracture to cement the broken bone. This callus is just a fibrous tissue and becomes coarser over time.

Stage 3: hard callus

Gradually, the body replaces the soft callus with a hard callus that connects bone fragments more firmly. This hard callus, which creates a kind of bump at the site of the fracture, can be seen on x-rays a few weeks after the fracture.

Step 4: Remodeling

The last step in the bone repair process is remodeling, when the body replaces the callus binder with new, more compact bone. Remodeling makes the bones stronger, while improving blood circulation in the bone tissue.

When a bone is fractured, doctors take certain actions aimed at achieving the correct and rapid recovery of damaged tissues:

• Positioning the bone and immobilizing the fracture. If necessary, the doctor will move the displaced bone segments back into place, after which the bone will be immobilized with a cast or brace.
• Operation . In some cases, patients need surgery to set the bone fragments in place and stabilize the fracture, a process that may involve the use of metal plates, screws, or nails. If the fracture does not show signs of fusion, additional treatment is necessary. Sometimes doctors prefer to do additional surgery. With the advent of the Exogen device, an alternative appeared for reoperation, which allows accelerating bone healing even with non-union fractures.
• Stimulation of bone growth. To help the fracture heal, you can use the Exogen device, the only stimulator that uses ultrasonic waves to stimulate the body’s natural repair processes, activating bone growth.
• Physiotherapy devices can be used to speed up metabolism and, accordingly, restore injured tissues. For example, a fracture is an indication for the use of MILTA or RIKTA laser therapy devices.

• Rehabilitation after a fracture. Fracture involves prolonged fixation of the bone in order to allow the tissues to heal properly. A negative effect of prolonged immobilization may be the loss of joint mobility, in other words, the occurrence of contracture. One of the reasons is that injured tissues are restored in a fixed position, which further does not allow the joint to fully bend.

Doctors recommend actively developing the joint after removing the cast or fixing orthosis using special exercises or Arthromot or Kinetek mechanotherapy devices, which independently flex the joint and gradually stretch the soft tissues. If the joint has been in a fixed position for a long time (more than 1-2 months), mechanotherapy is supplemented with manual or hardware techniques aimed at increased joint flexion, accompanied by tissue micro-ruptures. In the future, it is important that the tissues that have undergone microtears are restored in motion.

In addition to developing joint mobility, it is important to restore muscle tone with the help of special exercises or myostimulation

Find out more about exercises for rehabilitation after knee injuries and operations on the knee and knee joint, rehabilitation after shoulder injuries and operations on the shoulder and shoulder joint

Recommendations for patients who want to accelerate bone healing and recovery after a fracture:

• Avoid smoking and tobacco products that slow down bone healing
• Your diet should be balanced and contain essential nutrients such as protein, vitamins and trace elements. This will give the body energy and building material to repair damaged bones.
• Food contains a large amount of calcium, which is necessary for building bone tissue.
• Pain medications should only be taken when prescribed by a doctor, as some anti-inflammatory medications can inhibit bone healing.
• Successful recovery requires a lot of rest, as the body spends a lot of energy on recovery and must recover

The article is intended solely to inform about the disease and the tactics of its treatment and rehabilitation. Be sure to consult with your doctor about the methods of treatment and rehabilitation in relation to your situation.

what to do? – reference book Omega-Kyiv

Almost all bones in the human body fuse quickly after fractures. According to the observation, for the fusion of fractures of different localization, a certain amount of time is needed. So, for example, it takes about three weeks to splice the ribs and phalanges of the fingers, and at least one and a half months to treat a fracture of the shoulder or collarbone. These time limits were determined by the period during which the build-up of callus occurs in an ordinary person.

But it is not uncommon for bones to heal too slowly. Most often, this problem occurs with young children and the elderly.

• Osteoporosis. A disease in which there is a significant decrease in bone density. People with this disease are most prone to various fractures, as well as to a long recovery after an accident;
• Late visit to the clinic. Some patients, after an unsuccessful fall, observe swelling and swelling on the arm, leg, or some other part of the body. In many cases, this is a manifestation of a closed fracture, but without timely diagnosis, patients may consider this condition an ordinary bruise. It is precisely because of the untimely appeal to a specialist and the necessary manipulations that the patient experiences displacement and other aggravating circumstances;
• Insufficient amount of calcium. With calcium deficiency, in the human body, delayed formation of callus can occur. To restore the required amount of calcium in the body, the patient needs to revise his own diet, as well as use special drugs.

In order to find out which foods are most useful for fast bone healing, the patient should contact the clinic for a consultation with an orthopedic traumatologist.

There are several generally accepted recommendations that will help you recover quickly from a fracture. Of these, the most common are:

• Complete rest of the affected area of ​​the body. If the injured arm, leg or collarbone is not disturbed once again, then recovery will come much faster. First of all, this is due precisely to the fact that the callus grows gradually and with sudden movements, it can be disturbed or displaced;
• In order for calcium to be most well absorbed in the body, the patient needs to consume vitamin D. A large concentration of this element is found in fatty fish, eggs, dairy products;
• When bones are fractured, it is advisable to eat jelly from lean poultry meat. Some orthopedic doctors are of the opinion that gelatin can promote rapid bone fusion;
• It is necessary to expand the consumption of foods containing vitamin C. It is this element that is involved in the synthesis of collagen, which is necessary for many body tissues.