Clavicle fractures are extremely common injuries. The injuries usually caused by a fall onto the shoulder region itself. Sometimes, this results in an injury to the acromioclavicular joint often termed a shoulder separation. While painful, this injury can be overcome either with or without the need for surgery.
The most common area of the clavicle to break is at the midshaft, although fractures towards the end of the collarbone are also quite frequent.
This type of fracture is almost always the result of a fairly traumatic injury. Patient’s often feel the bone break! Afterwards, there is a sensation as if the ends of the bones are often grinding together. Movement of the shoulder is usually quite painful. Sometimes, there is the appearance of the bone almost coming through the skin although it is rare that this actually occurs.
This type of injury is easily diagnosed with an x-ray (See picture example):
There are 2 treatment options to be considered: Surgical treatment or nonsurgical treatment.
Nonsurgical treatment is, for the most part, the mainstay of treatment for this type of injury. The midshaft clavicle fracture typically healed quite reliably, although is often left with some form of deformity at the fracture site such that the patient is able to see the effects in the mirror. Fractures there more significantly displaced may be best treated surgically. Also, patients wishing to return to activities more quickly may find that surgery makes this possible.
Operative treatment for a clavicle fracture is usually done using a plate and several screws which hold the bony fragments in anatomical alignment and allow the bones to heal. Other techniques utilize pins to hold the pieces together. Postoperatively, most patients are quite comfortable and actually feel better than they did before going into the operating room. This is not common with all fracture surgeries and is unique to this situation. Depending on the patient, many can return to range of motion exercises of the shoulder within a few days.
Rehabilitation after both operative and non-operative treatment focus on restoring normal range of motion of the shoulder which may become stiff after a period of immobilization for the injury. This begins with simple pendulum exercises, and is increased to initially assisted range of motion, for example, walking one’s fingers of the wall and then eventually with a strengthening program. With appropriate treatment, there can be minimal or no long term effects of a clavicle fracture.
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