Sticks and Stones May Break My Bones…
… but is surgery required to heal them? This article discussed when and whether a clavicle fracture (also known as a broken collarbone) needs to be surgically repaired.
“Is surgical treatment for a clavicle fracture necessary?” is a question explored by EmergeOrtho—Triangle Region’s very own Dr. William P. Silver, Orthopedic Surgeon and Triangle Division Medical Director, who specializes in Sports Medicine and the treatment of Knee and Shoulder injuries.
In the video below, Dr. Silver shares the outcome of a recent study comparing a surgical and non-surgical approach to healing a displaced (pieces of the bone are separated) midshaft (mid-bone) clavicle fracture. REMEMBER: The type of treatment each patient undergoes depends upon numerous factors discussed during an in-depth consultation. With that said, Dr. Silver’s video can better prepare you for that initial meeting with your doctor.
The clavicle is one of the main bones in the shoulder and is the only bony connection between the arm and the rest of the skeleton. Accounting for 5% of all adult fractures, a clavicle fracture can be quite painful and greatly hinder arm mobility.
The clavicle is located between the sternum (ribcage) and scapula (shoulder blade), and connects the arm to the body. Most fractures occur in the middle of the bone, but sometimes it can break closer to either end where it attaches to the ribcage or shoulder blade.
The fracture can be a slight break, or break into many pieces (comminuted fracture). The broken pieces can either line up straight or be severely out of place (displaced fracture).
Cause and Symptoms
Clavicle fractures can occur in anyone at any age, for a variety of reasons. Common causes include:
- Direct blow to the shoulder resulting from a fall on an outstretched arm or sports impact
- Car collision
- Passage through the birth canal (applicable to clavicle fractures in babies)
Although symptoms vary, especially depending on the severity of the fracture generally, most people experience:
- Sensation of grinding with arm movement
- Pain with varying degrees of severity
- Deformity/bump on or near the site of the break
- General bruising, swelling, and tenderness
- Limited arm mobility
- Shoulder sagging and posture problems
If the fracture is minor to moderate and the bones are hardly out of place, one or more of the following non-surgical techniques will likely be recommended:
- Arm sling
- Figure of eight strap
- Pain medication
- Physical therapy
It is important to note, however, that clavicle fractures treated non-surgically require caution. Great care needs to be taken to ensure that the bones do not move out of place before they are fully healed. If they do, the bones may heal in their displaced position (also known as a malunion), causing a permanent bump over the site of the fracture or drooping of the shoulder, which may hinder the movement of your arm.
If the fracture is more severe, with the bones considerably out of place, surgery may be recommended.
The procedure most commonly used to treat clavicle fractures is an open reduction with internal fixation. During this procedure, the bones are repositioned (reduced) to their normal alignment, and then they are held in place (fixed) with either plates and screws or pins.
Surgery provides a greater chance of the bones healing properly versus non-surgical methods, and also increases the chance of you regaining your shoulder’s strength and mobility quicker.
It is important to note that surgical treatments are more prone to complications than their non-surgical alternatives, making surgery higher risk. Given there are trade-offs with either method of management, thoughtful consideration of the method of treatment is needed.
The Clinical Study
In the video, Dr. Silver explores a study (published in Volume 99, Issue 14 of The Journal of Bone & Joint Surgery) that compares surgical and non-surgical treatment approaches for displaced midshaft clavicle fractures.
The authors conducted a prospective, randomized, controlled trial of 117 patients who received either non-surgical treatment with a figure-of-eight harness or surgical treatment with a plate and screws. At the six-week, six-month, and one-year follow ups, they found no difference between the two groups in terms of function, pain scores, time to return to previous activities, or dissatisfaction with the appearance of the shoulder.
The authors did note, however, that seven non-surgical patients (14.9%) developed malunion, compared to none in the surgical group. Furthermore, non-surgically treated patients displayed radiographic evidence of greater clavicle shortening compared with those in the surgical cohort. And, more patients in the non-surgical group answered “yes” when asked if their clavicle felt short and if they felt bone prominence. In the surgical group, more patients answered “yes” when asked if they felt a sensation of numbness near the incision.
In light of the study, and to answer the initial question, “Is Surgical Treatment for a Clavicle Fracture Necessary?”—it depends. It depends on you, your fracture, and your needs.
To explore your options, you can schedule an appointment with Dr. Silver or any of our other highly qualified EmergeOrtho–Triangle Region doctors. Or, call us any time at (919) 220-5255.
Together, we can help you Emerge Stronger. Healthier. Better.