No problem, the midclarivular shaft fracture looks like it is definitely displaced and that there is some shortening of the clavicle, so while nonoperative treatment with a sling will definitely make it heal, it may not heal properly aligned. So there is definitively an option for surgical treatment. Here is the overview of both options:
If the broken ends of the bones have not shifted out of place and line up correctly, you may not need surgery. Broken collarbones can heal without surgery.
A simple arm sling or figure-of-eight wrap is usually used for comfort immediately after the break. These are worn to support your arm and help keep it in position while it heals.
Pain medication, including acetaminophen, can help relieve pain as the fracture heals.
While you are wearing the sling, you will likely lose muscle strength in your shoulder. Once your bone begins to heal, the pain will decrease and your doctor may start gentle shoulder and elbow exercises. These exercises will help prevent stiffness and weakness. More strenuous exercises can gradually be started once the fracture is completely healed.
You will need to see your doctor regularly until your fracture heals. He or she will examine you and take x-rays to make sure the bone is healing in good position. After the bone has healed, you will be able to gradually return to your normal activities.
The fracture can move out of place before it heals. It is important to follow up with your doctor as scheduled to make sure the bone stays in position.
If the fracture fragments do move out of place and the bones heal in that position, it is called a "malunion." Treatment for this is determined by how far out of place the bones are and how much this affects your arm movement.
A large bump over the fracture site may develop as the fracture heals. This usually gets smaller over time, but a small bump may remain permanently.
If your bones are out of place (displaced), your doctor may recommend surgery. Surgery can align the bones exactly and hold them in good position while they heal. This can improve shoulder strength when you have recovered.
Plates and Screws
During this operation, the bone fragments are first repositioned into their normal alignment, and then held in place with special screws and/or by attaching metal plates to the outer surface of the bone.
After surgery, you may notice a small patch of numb skin below the incision. This numbness will become less noticeable with time. Because there is not a lot of fat over the collarbone, you may be able to feel the plate through your skin.
Plates and screws are usually not removed after the bone has healed, unless they are causing discomfort. Problems with the hardware are not common, but sometimes, seatbelts and backpacks can irritate the collarbone area. If this happens, the hardware can be removed after the fracture has healed.
(A) The clavicle is broken in more than one place and the fragments are severely out of alignment. (B)The fractured pieces are held in place by a combination of plates and screws.
Reproduced with permission from Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR: Acromioclavicular and sternoclavicular injuries and clavicular, glenoid, and scapular fractures. Instructional Course Lectures, Vol. 59. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010, p 215.
Pins are also used to hold the fracture in good position after the bone ends have been put back in place. The incisions for pin placement are usually smaller than those used for plates. Pins often irritate the skin where they have been inserted and are usually removed once the fracture has healed.
After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.
Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.
Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
Specific exercises will help restore movement and strengthen your shoulder. Your doctor may provide you with a home therapy plan or suggest that you work with a physical therapist.
Therapy programs typically start with gentle motion exercises. Your doctor will gradually add strengthening exercises to your program as your fracture heals.
Although it is a slow process, following your physical therapy plan is an important factor in returning to all the activities you enjoy.
People who use any kind of tobacco product, have diabetes, or are elderly are at a higher risk for complications during and after surgery. They are also more likely to have problems with wound and bone healing. Be sure to talk with your doctor about the risks and benefits of surgery for your clavicle fracture.
There are risks associated with any surgery, including:
- Blood clots in your leg
- Damage to blood vessels or nerves
The risks specific to surgery for collarbone fractures include:
- Difficulty with bone healing
- Lung injury
- Hardware irritation