Treatment of Clavicle Fractures

December 27th, 2008

Historically, clavicle (collarbone) fractures have been treated nonoperatively, in a sling or figure of eight splint. However, a landmark study by the Canadian Orthopaedic Society, published in the Journal of Bone and Joint Surgery in January 2007 has provided compelling data to support operative treatment for displaced fractures.

When displaced mid-shaft clavicle fractures heal, without a reduction, a number of global function and satisfaction surveys reveal poorer patient-reported outcome, compared to the results after reduction and plate application. Further, acute surgery decreases the risk of nonunion, which, when present some 4 months later after an attempt at nonoperative care is considerably more challenging because of the inability to precisely obtain an "anatomic" reduction. Add to that the advantage after surgery of not requiring a lengthy periodof narcotic pain medicine compared to when surgery is not performed, and currently, best practice includes operative treatment of displaced midshaft clavicle fractures.

You may still have the "option" of "no surgery", but consider carefully the consequences.

Related Photos:

This preop xray shows displacement of the midshaft of the clavicle. This type of fracture is more optimally treated with surgery.

Anatomic reduction is maintained with the application of a plate and screws. The latest clinical research compellingly shows the value proposition of this method of treatment.

This acute fracture was not operated on per the patients wishes.

Though treated nonoperatively, the fracture took 4 months to heal, during which time she required narcotic pain medication, and had to limit her shoulder motion due to pain. The white arrow marks where the displaced fragment was positioned beneath her skin.

Ultimately, she required an operation to remove the prominance, which had caused considerable irritation of her soft tissue.