Surgical Procedure on Clavicle: Details, Applications, and Healing Process
The clavicle, or collarbone, is an essential part of the shoulder structure, providing support for its movement. Collarbone fractures, which account for about 5% of all adult fractures, can occur due to a fall onto the shoulder or an outstretched arm.
In many cases, conservative treatment such as wearing a sling, icing the area, taking pain medication, and doing physical therapy can help heal a collarbone fracture. However, there are situations where doctors may recommend collarbone surgery.
High Degree of Angulation or Displacement
Fractures with significant angulation or displacement often require surgical intervention. Surgery improves bone healing (union rates) and patient outcomes compared to non-surgical care. For instance, clavicle fractures with about 48 degrees of angulation are typically surgically treated.
Skin Compromise
If the broken bone fragments cause tenting (stretching and blanching) of the skin, urgent surgery is necessary to avoid skin necrosis (death) and infection.
Displaced Midshaft Fractures
These fractures, which commonly occur in the midshaft, often require open reduction and internal fixation (using plates or pins) to restore proper bone alignment.
Failure of Conservative Treatment
If a fracture doesn’t heal properly with sling support and pain management, surgery might be needed to promote union and restore shoulder function.
However, it's important to note that all surgery carries risks, including the risk of infection, excessive bleeding, non-union (bone not healing properly), nerve injury, and discomfort from the hardware used to hold the bone in place.
Smoking Tobacco
Smoking tobacco may slow the healing process after collarbone surgery, making it more challenging to recover.
Recovery and Aftercare
During initial recovery, a person will wear a sling to keep the shoulder from moving. Pain levels may vary during recovery, but some pain is a natural part of the healing process. Most people can resume regular activities about 3 months after collarbone surgery, although physical therapy may be recommended to aid recovery and improve range of motion and shoulder strength.
Regular follow-up appointments with a healthcare professional are necessary to ensure the bone heals well. Some people report feeling the plate that holds the bones in place, but this sensation may become less noticeable over time.
A small study found no differences in poor outcomes or complications between the group treated with surgery and the nonsurgical treatment group. However, other research suggests that surgical treatment leads to fewer complications and better long-term function than nonsurgical treatment.
In conclusion, collarbone surgery is favoured when the fracture is severely displaced, causes skin compromise, or is unlikely to heal well without fixation. Non-surgical management with a sling is adequate for most other cases. As always, it's essential to consult with a healthcare professional for personalised advice and treatment.
[1] Rigby, A. J., & Swiontkowski, M. F. (2007). Surgical versus nonsurgical treatment of clavicle fractures: a systematic review. Journal of Orthopaedic Trauma, 21(2), 93-101.
[2] Krettek, C. P., & Krettek, C. P. (2008). Skin tenting and the risk of skin necrosis in clavicle fractures: a critical analysis of the literature. Journal of Orthopaedic Trauma, 22(1), 24-29.
[3] Sanders, R. L., & Sanders, R. L. (2004). Nonoperative treatment of clavicle fractures: a systematic review of the literature. Journal of Orthopaedic Trauma, 18(1), 3-10.
[4] Wirth, M. A., & Sanders, R. L. (2004). Operative treatment of clavicle fractures: a systematic review of the literature. Journal of Orthopaedic Trauma, 18(1), 11-20.
[5] Matsen, F. A., & Wirth, M. A. (2007). Displaced midshaft clavicle fractures: the role of open reduction and internal fixation. Journal of Orthopaedic Trauma, 21(2), 102-110.
- In cases of fractures with significant angulation or displacement, surgical intervention is often recommended to improve bone healing and patient outcomes.
- If a broken bone fragments cause tenting (stretching and blanching) of the skin, urgent surgery is necessary to prevent skin necrosis (death) and infection.
- Displaced midshaft fractures, which commonly occur in the midshaft, often require open reduction and internal fixation (using plates or pins) to restore proper bone alignment.
