Collar bone (Clavicle) fracture fundamentals
The clavicle or collarbone connects the shoulder to the chest wall. Fractures of the clavicle can result from either an indirect trauma with a fall to an outstretched arm or, much less commonly, they occur due to a direct blow to the collarbone.
Those sports that have a high probability for direct or indirect trauma from falls or contact are most likely to result in clavicle fractures. Examples include football, hockey, and skiing. In addition, high velocity trauma may be a cause for a clavicle fracture.
What are the symptoms?
As with any fracture, the patient experiences acute clavicle or shoulder pain, swelling and bruising. Moving the arm results in more pain.
What are my treatment options?
Immediately after injury, the affected arm should be immobilized in a sling for comfort. To reduce swelling and pain, ice may be applied and anti-inflammatory medication or oral analgesics used if appropriate.
Most clavicle fractures are treated without surgery, and patients are very happy with their shoulder function despite the presence of a bump where the fracture healed.
Surgery may be appropriate when the fracture fragments are widely separated. Surgery is also recommended when nerve vessel injury has taken place or if the healing of the fracture has occurred in a mal-united position. If the fracture has broken through the skin, then surgery is appropriate to minimize the risk of infection.
Surgery often involves using devices to fixate the fracture site internally. There are several devices available to fix clavicle fractures. The most appropriate one for you will depend on the type of fracture you have.
What are the risks of surgery?
Some of the risks include infection, wound healing problems, bleeding and injury to nerves and vessels near the fracture. Sometimes the shoulder gets very stiff. Occasionally, the fracture does not heal, and another operation may be recommended.
How do I prepare for surgery?
Try to be as informed as possible about the operation, including its goals and risks. The surgeon will explain these to you, and we encourage you to ask questions.
- Complete any pre-operative tests or lab work prescribed by your doctor.
- Arrange to have someone drive you home from the hospital.
- Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call:
- Main Campus: 216.444.HAND (4263)
- Lutheran Hospital: 216.363.2311
- Refrain from eating or drinking anything after midnight the night before surgery.
What do I need to do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water.
- Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
- Leave valuables and money at home.
- Wear loose-fitting, comfortable clothing.
What happens after surgery?
We will ensure that you are comfortable and that you have adequate shoulder pain relief. You will receive prescriptions, etc. Your arm will be rested in a sling. Your surgeon and physical therapist will let you know whether any exercises are required.
How long is the recovery period after surgery?
Post-operative care following clavicle fixation involves limited use of the arm for a six- to eight-week period at which point the arm can be used for daily activities, such as dressing, bathing, washing and eating. However, you should avoid lifting, reaching, pushing or pulling until your doctor gives you permission to do so.
Fracture healing may take up to four months, but early fracture healing typically occurs in the first two months at which point movement can be increased and a rehabilitation program can begin. After 12 to 16 weeks, you can begin a more aggressive strengthening program. Your doctor will examine you and obtain X-rays to determine whether you should progress in your activities.
Total recovery varies from 12 weeks to nine months from the time of the fracture. Recovery time is dependent upon the healing potential of the patient and the severity of the fracture.
What is the rehab after surgery?
In the first few weeks, you will need to do gentle exercises to prevent stiffness and shoulder pain. Later, physical therapy includes exercising with lightweights and bands. Once there is a solid union of the fracture fragments, more aggressive, gym-level strengthening can begin.
How can I manage at home during recovery from the procedure?
This will depend upon you and the presence of other injuries. You will be able to dress, feed and bathe yourself within a few days. However, you should keep the wound dry for the first five to 10 days.
How frequently should I schedule follow up appointments with my doctor following surgery?
You will be informed about the timing of you checkups. Your doctor will review your progress and your X-rays periodically to let you know when to progress to the next level of activity.