Historically, clavicle (collarbone) fractures have been treated nonoperatively, in a sling or figure of eight splint. However, a landmark study by the Canadian Orthopaedic Society, published in the Journal of Bone and Joint Surgery in January 2007 (attached below as a PDF) has provided compelling data to support operative treatment for displaced fractures.
When displaced mid-shaft clavicle fractures heal, without a reduction, a number of global function and satisfaction surveys reveal poorer patient-reported outcome, compared to the results after reduction and plate application. Further, acute surgery decreases the risk of nonunion, which, when present some 4 months later after an attempt at nonoperative care is considerably more challenging because of the inability to precisely obtain an "anatomic" reduction. Add to that the advantage after surgery of not requiring a lengthy periodof narcotic pain medicine compared to when surgery is not performed, and currently, best practice includes operative treatment of displaced midshaft clavicle fractures.
Obviously not having surgery remains a viable option, despite the findings in the 2007 JBJS report. At times, however, later surgery will be required or elected. In that situation one may question whether outcomes are aceptable, when there has been delay. Although these cases are more difficult, as I have suggested, there is a report from the Journal of Shoulder and Elbow Surgery (attached below) which intimates that outcomes are acceptable.
1 comment
mtomaino 3/7/11 at 8:21 am
I saw a 14 year old patient last week, a mere 8 weeks after surgery for a displaced clavicle fracture. His video is attached--he was healed and had full range of motion and no pain.
Over the past 5 years, the pendulum has really swung towards more aggressive treatment of clavicle fractures when significant displacement exists. The articles above provide good data in support of this approach, in terms of restoring normal shoulder function, as opposed to what may occur if these displaced fractures were allowed to heal in a malunited position.
This is usually a 1 hour operation performed under both a general and regional anesthesia. In most cases the regional block provides an 8-10 hour period of pain relief postoperatively, which allows discharge the same day.