Surgery for Clavicle Fracture (Broken Collarbone)

Frequently, a fractured clavicle (collarbone) can be treated without surgery. However, sometimes the fractured pieces of bone are out of position (displaced) or other factors about the injury or patient make surgery the better treatment option.

See Treating a Clavicle Fracture

Conventional wisdom and mixed opinions regarding clavicle surgery
In the past, conventional wisdom was that a broken clavicle would nearly always heal properly without surgical intervention. Some experts now question this notion, and there is no consensus on the treatment of most displaced clavicle shaft fractures. For example:

• A 2017 study¹Woltz S, Krijnen P, Schipper IB. Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Controlled Trials. J Bone Joint Surg Am. 2017;99(12):1051-1057. reviewing more than 600 patients noted that surgery can reduce the risk of a non-union (when the broken pieces of the clavicle bone fail to heal back together) but concluded that surgical and nonsurgical patients had similar shoulder strength and range of movement after healing.
• Another study²Mckee RC, Whelan DB, Schemitsch EH, Mckee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am. 2012;94(8):675-84. that looked at more than 400 patients concluded that surgery shortens healing time and therefore would allow athletes to return to play sooner. The same study also observed better, more compete healing in surgical patients, but only a small improvement in long-term shoulder strength and range of motion when compared to nonsurgical patients.

Until more definitive research is available, this topic will remain controversial. For now, surgery to repair a broken clavicle is often optional and not required, so the doctor and patient must consider the potential advantages and risks of surgery.

Types of Surgery for Clavicle Fracture

Surgery for a fractured clavicle typically involves an open incision to move the bone fragments into proper position and then secure them in place. There are 2 common surgical options:

• Plate fixation, which entails attaching a plate with screws to the outside of the bone
• Intramedullary fixation, which involves inserting a long pin into the center of the bone

Both plate fixation and intramedullary fixation have advantages and disadvantages.

Intramedullary fixation typically uses a smaller incision and causes fewer disturbances to the surrounding soft tissues. However, intramedullary fixation sometimes requires a second surgery to remove the hardware.

Plate fixation hardware is usually left in place but occasionally causes irritation from seatbelts or backpack straps, because the clavicle is prominent and close to the skin’s surface. Research shows³Naimark M, Dufka FL, Han R, et al. Plate fixation of midshaft clavicular fractures: patient-reported outcomes and hardware-related complications. J Shoulder Elbow Surg. 2016;25(5):739-46. that about 10% to 15% of plate fixation patients decide to have their hardware removed, and that women are more likely than men to undergo removal.

Hardware removal is done as an outpatient surgical procedure, usually with general anesthetic. Removal of hardware results in small voids in the bone (typically holes previously occupied by screws) and the surgeon may recommend the patient take postoperative precautions to prevent injury. However, the recovery overall is generally much faster than recovery from the original fixation surgery because the fracture should already be healed, and the associated soft tissue injury is less than at the time of the initial fracture.

Patients should consult with their surgeons to determine the approach that is right for them.

Managing Post-Surgical Pain

An anesthesiologist may administer a peripheral nerve block that numbs the area around the clavicle, where the surgeon will operate. A peripheral nerve block can be used along with general anesthesia. Following surgery, the peripheral nerve block may work for a brief time after the general anesthesia has worn off. This allows a patient to emerge from general anesthesia and regain consciousness without pain.

Whether a peripheral nerve block is used or not, the patient will eventually experience pain that must be managed.

Pain can be managed with these tactics:

• Taking prescribed opioid (narcotic) pain medication during the short term. It is important to take opioids only as directed.
• Taking non-steroid anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen once the patient is no longer taking an opioid.
• Using cold therapy for 10 to 15 minutes several times a day. This decreases inflammation and dulls pain signals to the brain.
• Propping pillows around the affected arm to help with sleep, or perhaps sleeping upright in a comfortable chair for the first few nights after surgery.

See The P.R.I.C.E. Protocol Principles

Physical therapy will typically begin a few weeks after surgery. Physical therapy can help patients restore range of motion, eliminate stiffness and, eventually, rebuild strength. Most clavicle fractures are healed after about 6 to 12 weeks.