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| Clavicle Fractures (Broken Collar Bones) |
The clavicle or collar-bone is one of the most frequently broken bones in the body. It acts as a strut to keep the shoulder in the right place and is the only bone to bone link between the arm and the body. It can be broken either by a direct contact across it or by a fall onto the hand, elbow or shoulder where the forces are transferred along it and can cause it to break.
Traditionally collar-bone fractures were treated non-operatively. This means that it was very rare for an orthopaedic surgeon to do an operation to line up the parts of the break and that would only be done if the bone was 'tenting' the skin and threatening to break through it or if the break had not healed as it was expected to.
And mostly that is the right way to treat most of them.
However, shoulder specialists tend to see more and more of the ones that didn't do so well by being treated in a sling. Recently research has shown that there are certain patterns of fracture which should be treated with an operation because they either tend not to heal up or they heal in a way that cause shoulder problems in later life.
So shoulder surgeons have now reviewed the way we treat clavicle fractures and are much keener to fix certain types of break to avoid these complications.
I have a broken collar-bone. Do I need an operation?
Most clavicle fractures will heal uneventfully and without complication without surgery. If you have sustained a high-energy fracture (eg a motorbike crash or ski wipe-out) where the ends of the bones are either displaced by their own width or overlapped by more than 2 cms or are tenting the skin or any combination of these elements, then I would suggest you need an operation to line the parts up and maximise the chance of the bone healing straight and at the right length.
Most clavicle fractures will heal uneventfully and without complication without surgery. If you have sustained a high-energy fracture (eg a motorbike crash or ski wipe-out) where the ends of the bones are either displaced by their own width or overlapped by more than 2 cms or are tenting the skin or any combination of these elements, then I would suggest you need an operation to line the parts up and maximise the chance of the bone healing straight and at the right length.
What operation do I need?
I now use a metal pin placed into the medullary cavity (the bone marrow channel) of the clavicle which allows me to 'skewer' the pieces of bone and line them up properly and at the right length. The benefit of this technique is that it can be done through a much smaller incision than the traditional plate and screws so the risk of the break not healing, even after surgery, is further reduced and the design of the pin actually pulls the bone ends together which encourages them to heal.
Is this a day-case operation?
Yes it is. It's done under a general anaesthetic and the procedure takes about 45 minutes. You should be happy to go home a few hours afer surgery.
Do I need a sling?
Yes. You go home in a sling but you are allowed out of it regularly to exercise the hand , wrist and elbow. The sling is for two weeks but if you are happy then you can spend quite a lot of time out of it. Just avoid strenuous activities such as lifting, pulling or using the arm above shoulder height.
What about showers and baths?
The scar is usually about 4-5 cms long and is closed with a dissolving stitch. So for baths and showers you can cover the wound with a waterproof plaster and once you are dried, take the waterproof one off and cover the wound with a breathable plaster. After 4 - 5 days you are actually fully waterproof and don't need to keep the wounds covered at all.
I now use a metal pin placed into the medullary cavity (the bone marrow channel) of the clavicle which allows me to 'skewer' the pieces of bone and line them up properly and at the right length. The benefit of this technique is that it can be done through a much smaller incision than the traditional plate and screws so the risk of the break not healing, even after surgery, is further reduced and the design of the pin actually pulls the bone ends together which encourages them to heal.
Is this a day-case operation?
Yes it is. It's done under a general anaesthetic and the procedure takes about 45 minutes. You should be happy to go home a few hours afer surgery.
Do I need a sling?
Yes. You go home in a sling but you are allowed out of it regularly to exercise the hand , wrist and elbow. The sling is for two weeks but if you are happy then you can spend quite a lot of time out of it. Just avoid strenuous activities such as lifting, pulling or using the arm above shoulder height.
What about showers and baths?
The scar is usually about 4-5 cms long and is closed with a dissolving stitch. So for baths and showers you can cover the wound with a waterproof plaster and once you are dried, take the waterproof one off and cover the wound with a breathable plaster. After 4 - 5 days you are actually fully waterproof and don't need to keep the wounds covered at all.
Does the pin have to come out?
Yes, we advise that the pin comes out once the bone is healed. I see you in the clinic and take check x-rays 2 weeks after the operation and 8 weeks after. If at that stage the x-ray shows the bone is healed then I can take the pin out though I usually do this at 12 weeks after the operation. The pin is taken out as a day-case procedure under a general anaesthetic.
Yes, we advise that the pin comes out once the bone is healed. I see you in the clinic and take check x-rays 2 weeks after the operation and 8 weeks after. If at that stage the x-ray shows the bone is healed then I can take the pin out though I usually do this at 12 weeks after the operation. The pin is taken out as a day-case procedure under a general anaesthetic.
When can I return to work and sports?
If you have a desk job then you can go back pretty much straight away. For a heavy physical job then it's likely to be about 6 to 8 weeks.
You can start non-contact sports such as swimming, cycling and jogging between 2 and 4 weeks but you need to go slowly and gently. Impact or collision sports such as rugby, basketball and football can restart once the fracture is healed.
If you have a desk job then you can go back pretty much straight away. For a heavy physical job then it's likely to be about 6 to 8 weeks. You can start non-contact sports such as swimming, cycling and jogging between 2 and 4 weeks but you need to go slowly and gently. Impact or collision sports such as rugby, basketball and football can restart once the fracture is healed.