Clavicle fractures, or collarbone fractures, are not an uncommon injury. More recently, the injury to Tony Romo of the Dallas Cowboys stirred up interest in clavicle fractures. This type of injury is common in contact sports, bicycle accidents or, in Texas, falls from a horse. It is one of the most commonly fractured bones.
The clavicle is an S shaped bone which is part of the shoulder girdle and helps suspend the arm by attaching the upper limb to the trunk. It is a very superficial bone without a significant amount of muscular attachments, which makes it at risk for fractures.
Treating Clavicle Fractures
Historically, clavicle fractures were almost always treated without surgery, unless, it was an open fracture. An open fracture is when part of the bone has penetrated the skin. These fractures all need surgery to prevent infection. In the last 10-15 years, clavicle fractures are being treated with surgery at a much higher rate.
Surgery vs. Non-Surgery
When I see patients, I always present options of surgery vs. non surgery to patients. Things to consider are age of patient, activity level, patient expectations, location of fracture, amount of displacement of fracture, neurovascular status, and other medical conditions such as diabetes and tobacco use.
If a patient has low demands, then I usually recommend non-operative treatment. If the patient is very active and wants a faster return to activity, then I usually recommend surgery. Some of the benefits of surgery include: anatomic fixation, more reliable healing, less chance of strength loss, faster return to non-contact activities, faster rehabilitation, and less pain in the early weeks after fracture.
The risks of surgery includes:
- injury to nerves or vessels
- hardware irritation
- risks of general anesthesia
If the clavicle is in very good position where the bones are still in contact, then surgery is not indicated. However, if the bones are far apart with other small fragments of bone (comminution), then surgery is a good option. Surgery can consist of a plate and screws, or in some cases, a metal nail which can be placed inside the bones and cross the fracture to hold it in place.
Each type of surgery has its own unique risks. I use plates and screws in order to achieve rigid fixation and avoid hardware migration. The newer plates used today are more anatomic type plates, which sit lower profile, and the screws lock into the plate, which makes them less irritating.
After surgery, my patients are much more comfortable and I begin them on very early range of motion. They are usually back to light activities in 4-6 weeks and wait 3 months before participating in contact sports.