What Is a Clavicle Fracture Fixation?
Clavicle fractures (broken collarbone) are a common injury. A direct blunt force trauma to the shoulder such as from a fall, auto accident or sports injury is a common cause of a broken collarbone.
Clavicle fractures vary from a slight crack to multiple breaks (comminuted fracture). The broken bone may still be aligned properly; or, the pieces may move out of place (displaced fracture). While most breaks of the collarbone heal well with nonsurgical treatment, more complicated breaks may require surgery to realign the bones – a clavicle fracture fixation.
Shoulder and clavicle anatomy
The clavicle is one of the main bones of the shoulder. It is a long, thin bone located between the sternum (breastbone) and the scapula (shoulder blade). The clavicle suspends the shoulder joint from the torso.
How Fractures Heal
A fracture is another term for a broken bone. For a fracture to heal properly, the bones must be held in the correct position and protected from further injury.
After a fracture occurs, the body immediately starts the healing process by forming a blood clot and callus around the fracture. Bone cells begin to grow on both sides of the fracture and grow toward each other to close the fracture. The callus is then absorbed by the body. This process may take up to a year, but varies greatly depending on individual factors, such as
- Type of fracture
- General health
- Chronic conditions
…and more. If the fracture has not displaced the bone structure, surgery may not be required.
More severe fractures may require clavicle fixation. Indications for clavicle surgery include:
- Bones have significantly shifted out of place
- Bone is broken in several places
- Bone has broken through the skin
Fixation and immobilization methods
The most used surgical procedure is called an open reduction and internal fixation (ORIF). Clavicle fracture fixation surgery includes placing fixation devices (plates and screws, screws or pins/rods) to maintain proper alignment of the clavicle as it heals.
How the Procedure Is Performed
The doctor will ask how the injury occurred and associated symptoms. A physical examination will be performed, and tests may be done to check for nerve or blood vessel damage. X-rays may be ordered to help locate the exact position of the fracture and its severity and to check for additional injuries. A computerized tomography (CT) scan may be ordered to see additional broken bones in better detail.
Open reduction and internal fixation (ORIF)
A team of specialists, including an orthopedic surgeon, will perform ORIF surgery, which takes approximately two hours. Most ORIF procedures are done under general anesthesia, with or without a nerve block. A breathing tube may be used during surgery to ensure proper breathing.
During a clavicle fixation surgery, first the bone is reduced (repositioned) to restore proper alignment. There are two types of reductions – open and closed. In a closed reduction, the bones are mechanically moved back into place by a doctor without surgery. Because the doctor performing the reduction does not open the skin, a closed reduction is not surgery.
During an open reduction, surgery is used to reposition the bones into proper alignment. The surgeon will make an incision in the skin and muscle near the clavicle and then reposition the bones.
Second, internal fixation is used to physically reconnect the broken bones. Metal plates and screws are attached to the outer surface of the bone to hold it in place. If other surgical repairs are required, such as additional broken bones, they are also completed during this time. Once the bones have been secured, the surgeon will close the incision.
After collarbone surgery, the plate may be evident under the skin and a small area of numbness may also be present. The screws and plates are left in place unless they cause discomfort. If the irritation poses problems, they may be removed after the bone has fully healed.
Pins or screws or wires are an alternative to using metal plates. The benefit of using pins or screws is smaller incisions than those used for plates. However, pins and screws often irritate the skin and usually need to be removed once the bone has fully healed, and research indicates that use of plates may be a better healing option. The surgeon will discuss which options work best based on each individual case.
As with any surgery, there are potential risks and complications. Complications associated with a broken collarbone surgery include:
- Blood clots
- Damage to nerves
- Damage to blood vessels
- Improper wound healing
- Failure or difficulty with bone healing
- Malunion may occur if bone fragments move out of place during the healing process. A bump may form over the fracture.
- Injury to a lung
- Internal fixation hardware irritation
Medication for pain control will be given. The doctor will determine if a prescription pain medication is needed. Fluid may drain from the incision site, which is normal. However, there are some signs that require immediate medical attention, including:
- High fever or chills
- Severe pain
- Increase in swelling, redness, or draining of fluid
- Loss of feeling anywhere in the body
A sling will need to be worn to keep the shoulder immobilized during clavicle surgery recovery time. The length of time the sling will be required is based on the severity of the injury, varying from three to six weeks for children and six to 12 weeks for adults. Follow-up visits with the doctor will also be required and additional x-rays to check on bone healing progress.
Limited use of the arm is allowed for the first six to eight weeks post-surgery. This includes light daily activities, such as bathing, eating and dressing. Lifting, reaching, pulling or pushing should all be avoided until a doctor clears the patient to do these activities again.
Some arm and shoulder strength is usually lost after a clavicle fracture; however, once the bone begins to heal, physical therapy and home exercises will help regain this strength and pain will be reduced. More strengthening exercises are usually prescribed once the fracture had completely healed. Therapy results may be slow; however, the exercises are key to a successful, full recovery.
The complete recovery time is 12 weeks to 9 months. Each patient is different and the healing rate will vary depending on many factors, including but not limited to lifestyle, adherence to exercises, the patient’s own rate of healing, and the severity of the fracture. Patients who smoke or use tobacco, are diabetic or elderly have a higher risk of complications during and after surgery, as well as a higher risk of problems with proper wound and bone healing.