What Is The Clavicle Bone?
The clavicle is an S-shaped bone that connects to the sternum medially and to the scapula laterally.
What Is A Clavicle Fracture?
Traditionally clavicle fractures were managed conservatively in the pediatric, adolescent, and adult population, but more recent studies have shown that operative intervention may allow patients to return to activities more quickly, have a quicker radiographic union, less chance of nonunion or malunion, and less pain during recovery. Clavicle malunion is then a result of clavicle shortening and displacement. A malunion can potentially alter the kinematics of the scapula, leading to scapular dyskinesis and malrotation. Studies show that the clavicular malunion in skeletally mature patients causes a decrease in strength and velocity with certain movements of the upper arm. Some think that this may be true in adolescent patients as well.
Is My Clavicle Bone Fractured?
Plain x-rays evaluate the clavicle fracture and assess the fracture pattern, displacement, angulation, comminution, and shortening. After the fracture is assessed, appropriate management is decided upon one of our New Jersey orthopedic doctors at the Advanced Orthopedics & Hand Surgery Institute.
What Do Clavicle Fractures Look Like?
Here is an example of a 51-year-old male who suffered a clavicle fracture from falling off a bike. The midshaft clavicle fracture had a superiorly displaced medial aspect with at least four interposing comminuted fragments. He was a good candidate for a clavicle open reduction and internal fixation with a plate and screws.
Here is an example of a 22-year-old male with an 8-month-old clavicular malunion. His clavicle fracture was treated conservatively in a sling and healed in a shortened position. The patient was having persistent pain and postural issues. He was indicated for a clavicular osteotomy and open reduction and internal fixation with a plate and screws. This required us to rebreak his clavicle to restore normal length.
Pediatric Clavicle Fractures
Typically, pediatric clavicle fractures with little displacement and minimal shortening can receive nonsurgical treatment. Treatment generally consists of immobilizing the arm in a sling for 4 weeks. After that point, the patient can begin ROM and will generally be ready to return to activities 8-12 weeks after the fracture.
Will I Definitely Need Surgery?
Surgical management of midshaft clavicle fractures is usually warranted when there is >15mm of significant shortening, 100% displacement, or significant comminution especially in pediatric patients involved in high demand activities. Studies show that in pediatric patients 10 years and older with these fracture patterns use of an elastic stable intramedullary nail leads to less pain during recovery, increased patient satisfaction, and less time immobilized.
Clavical Surgery Options
There are two options to consider for Clavicle surgical management. The first is fixing the bone with a plate and screws that lie on top of the bone. This will provide a secure and adequate reduction, although it does require stripping of muscle off the bone where the plate will rest. The plate and screws also require an extensive incision over a good portion of the clavicle to position it properly. The patient may be able to feel the plate after surgery and it can potentially be bothersome when wearing a backpack, purse, or anything that puts pressure on the collarbone. A clavicle plate may require removal with a second surgery due to the irritation it causes. Despite the drawbacks of using a clavicle plate and screws, it may be the best option if the fracture is significantly comminuted or in multiple pieces.
The second option is then fixing the bone with a clavicle nail. A clavicle nail sits inside the bone in the intramedullary canal. This eliminates the need to strip down muscle overlying the clavicle. This Clavicle surgery option is done through three small incisions. The hardware is then placed inside the bone and cannot be felt by the patient after surgery. The clavicle nail also eliminates the irritation that patients sometimes experience from straps and backpacks. This hardware rarely requires removal after surgery.
Schedule A Consultation
For more information on clavicle fracture surgeries, or to schedule an appointment, call Advanced Orthopedics and Hand Surgery in Wayne and Clifton, New Jersey. Call (973) 942-1315 today!