Clavicle Fracture

Clavical Fracture Treatment in Wayne & Paramus, NJ

The clavicle, also known as the collar bone, is an S-shaped bone that connects to the sternum.

Clavicle Fracture (Collar Bone Fracture)

The clavicle is an S-shaped bone that connects to the sternum medially and to the scapula laterally. A clavicle fracture can occur from direct trauma or falling onto the shoulder or arm. It is not uncommon to see clavicle fractures in cyclists, snowboarders, or football players who have fallen onto the shoulder. The fracture can occur anywhere along the length of the bone although it most commonly occurs in the middle portion of the bone. 

Most athletes that have suffered a clavicle fracture will present with pain over the clavicle and a history of trauma. There may be tenting or pushing up of the skin over the fracture site. The clavicle bone site close to the skin surface and a displaced fracture or sharp fracture edge may threaten the skin. Our doctors will carefully examine your shoulder and clavicle area and order x-rays. Plain x-rays are used to evaluate the clavicle fracture and assess the fracture pattern, displacement, angulation, comminution, and shortening. After the fracture is assessed, appropriate management is decided upon by your orthopedic doctor. Generally, further imaging is not necessary unless your doctor suspects any tendon or ligament damage related to the injury. 

Traditionally, clavicle fractures were managed conservatively in the pediatric, adolescent, and adult population, but more recent studies have shown that operative intervention may allow patients to return to activities more quickly, have quicker radiographic union, less chance of nonunion or malunion, and less pain during recovery. Clavicle malunion is usually a result of clavicle shortening and displacement. A malunion can potentially alter the kinematics of the scapula, leading to scapular dyskinesis and malrotation. Studies have shown that clavicular malunion in skeletally mature patients causes decrease in strength and velocity with certain movements of the upper arm, and it is thought that this may be true in adolescent patients as well. 

Typically, pediatric clavicle fractures with little displacement and minimal shortening can be treated without surgery. Treatment generally consists of immobilizing the arm in a sling for 4 weeks. After that point the patient can begin range of motion and will generally be ready to return to activities 8-12 weeks after the fracture. 

Surgical management of midshaft clavicle fractures is usually warranted when there is >15mm of significant shortening, 100% displacement, or significant comminution especially in pediatric patients involved in high demand activities. It has been shown that in pediatric patients 10 years and older with these fracture patterns use of an elastic stable intramedullary nail leads to less pain during recovery, increased patient satisfaction, and less time immobilized. 

There are two options to consider when surgical management is decided. The first is fixing the bone with a plate and screws that lie on top of the bone. This will provide a secure and adequate reduction, although it does require stripping of muscle off the bone where the plate will rest. 

 

The plate and screws also require an extensive incision over a good portion of the clavicle so it can be positioned properly. The patient may be able to feel the plate after surgery and it can potentially be bothersome when wearing a backpack, purse, or anything that puts pressure on the collarbone. A clavicle plate may oftentimes need to be removed with a second surgery due to the irritation it causes. Despite the drawbacks of using a clavicle plate and screws it may be the best option if the fracture is significantly comminuted or in multiple pieces. 

Clavicle Fracture (Collar Bone Fracture)

The second option is fixing the bone with a clavicle nail. Although, this is a good option it is not appropriate for every fracture. A clavicle nail sits inside the bone in the intramedullary canal.

This eliminates the need to strip down muscle overlying the clavicle. The surgery is done through three small incisions. The hardware is placed inside the bone and cannot be felt by the patient after surgery. The clavicle nail also eliminates the irritation that patients sometimes experience from straps and backpacks. Rarely is this hardware removed after surgery. Our doctors will closely monitor your progress and healing with x-rays after surgery. Physical therapy may be part of your rehabilitation to help regain your motion and strength. Your doctor will let you know when it is safe to return to play and at what point you are released to use the hand without restrictions.

A clavicle fracture can cause serious setbacks for any athlete. Our goal at Modern Orthopaedics is for you to return to your sport better than before. This may take time and patience, but we want you to experience a full recovery. We understand that each athlete and sport is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office to have an initial evaluation for a shoulder or clavicle injury and receive superior care from our doctors and staff. 

Video: Collarbone Fractures - A Guide to Management

Learn about surgical options for treating your collarbone fracture.

Transcript:

The clavicle, also known as the collarbone, is commonly fractured in people of all ages. Historically, most clavicle fractures were treated without surgery but more recent studies have shown that this type of non-operative management can lead to longterm dysfunction and, in adults, the bone has a higher likelihood of not healing.

I like to think of the clavicle as one leg of a tripod. If that leg is foreshortened, everything tends to lean. If the clavicle heals in a shortened position, your entire shoulder girdle will actually rotate inward, which is how this dysfunction occurs. I see operative intervention as having several benefits, reestablishing anatomic alignment to restore normal shoulder function, maximizing the chance of bone healing, and stabilizing the bone so that there is no painful clunking or clicking over the fracture ends.

Generally, there are two ways to surgically fix a clavicle bone. The first is with a plate and screw construct that overlays the bone and stabilizes it. This is a great option to restore stability and anatomic alignment, particularly when the fracture is significantly comminuted or in multiple pieces.

Second option, as in Ali’s, case is fixing the bone with a clavicle nail. This is a metal rod that is essentially hidden within the tubular structure of the bone and cannot be felt under the skin after surgery. This minimizes the chance of irritation from the straps of a backpack or a handbag. This surgical technique also minimizes the size of the incisions, which are about two and a half centimeters in length and fall in line with the clavicle. Once they’re healed, they are barely noticeable.

I like patients to limit their range of motion for the first four weeks to minimize the chance for displacement. Motion typically returns quickly and physical therapy is not usually necessary. Clavicle nails are really a great option for patients who have displaced clavicle fractures but want a nice cosmetic result and an early return to normal function.

Frequently Asked Questions

Most shoulder pain can be treated with rest, anti-inflammatories and physical therapy. Any primary doctor or general orthopedist can prescribe these simple solutions, but a trained shoulder specialist won’t just treat your pain — they will diagnose and treat your specific problem

At Modern Orthopaedics, our trained shoulder specialists will ask the right questions, perform specific examinations and order imaging when appropriate. They will be able to diagnose your problem and treat you whether your problem is simple or complex. Although you may not feel like your shoulder issue is “bad enough” to see a specialist, it is advantageous to have the opinion of an expert in the field when it comes to your health.

Before deciding on the treatment for your shoulder pain, our doctors will first diagnose your problem. Depending on the type and severity of your problem, the treatment options will vary.

Generally, physical therapy will be involved in the first step of treatment. You will work closely with a therapist two to three times a week to develop a routine that is tailored to your diagnosis and needs. Therapy may take some time to help, which is why a six-week trial is generally recommended before proceeding with other treatment options.

Cortisone injections are often used in orthopedics. Our doctors are conservative when it comes to using cortisone injections and reserve them for specific situations. They are most commonly used for patients who may have a stiff or frozen shoulder or shoulder arthritis. They use them less commonly for rotator cuff issues, but there are exceptions. Each patient’s situation is unique, and our doctors will work with you to ensure the highest level of care.

Surgical intervention is reserved for shoulder issues that do not respond to more conservative measures or acute injuries that need to be addressed right away. The most common shoulder surgeries performed by our doctors are done arthroscopically. This allows for smaller incisions and a quicker recovery for our patients. The length of recovery, immobilization period and rehabilitation protocol differ depending on the surgery.

Shoulder pain can arise from a variety of different issues. We commonly see patients who have had longstanding shoulder pain, did something to make it worse and have decided to have it looked at. They may have rotator cuff tendinopathy, a partial rotator cuff tear or maybe even a full-thickness tear. Some patients are very active — often times athletes who have had an injury in the past. They continue to have shoulder pain with certain activities and want to know what their prognosis is. These patients may have a labral tear, a rotator cuff tear or an overuse injury.

Other patients come into our office with shoulder stiffness. They usually noticed that their shoulder became progressively stiff and painful. Once it becomes dysfunctional and affects their daily life, they call for an appointment. This is most commonly adhesive capsulitis, also known as a frozen shoulder. Sometimes, patients will come in with a longstanding history of shoulder pain and crepitus. They may have shoulder arthritis. Other patients present with severe acute shoulder pain that may be from calcific tendonitis.

Regardless of the shoulder problem, our specialists are eager to help you achieve your goals, whether that is getting you back to the game you love, decreasing your pain, increasing your motion or helping you sleep at night.

Personalized care

As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free. 

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