Home Blog Clavicle Fractures - Do I need surgery?
Clavicle Fractures - Do I need surgery?



The other day I saw and fixed one of the worst clavicle fractures I have ever seen – in another physician no less - biking accident, 5 pieces, about 1 ½ hrs of surgery time to put the jigsaw puzzle back together. In the end, I was pleased with how it came together; I think the fracture will heal and he will do well. 

But it made me wonder about what the latest research shows regarding clavicle fractures – should they all be fixed? If not, which ones should and why? Historically all clavicle fractures were treated without surgery and the great majority went on to heal. 

But recent literature suggests that some of these patients did not fare so well when it comes to regaining all their motion, strength, and function.

claviclesxA recent prospective, randomized study of more than 100 displaced clavicle fractures found that it took an average of 28 weeks to heal without surgery and an average of 16 weeks to heal with surgery. Most people would probably like to return to their activities, usually sports, sooner rather than later.

That said, it should be noted again that the majority of clavicle fractures heal on their own. So when do you fix a clavicle?

Indications for fixing a clavicle include open fractures (bone sticks out of skin), tenting fractures (bone going to stick out of skin if nothing is done), displaced fracture with 2cm or more of shortening, multi-extremity involvement, floating shoulder (scapula fracture with clavicle fracture), seizure disorders, and cosmesis. Other variables to consider include how comminuted the fracture is (how many pieces), age of patient, and how healthy the patient is.

According to some studies, ORIF (fixing the fracture) enables athletes with displaced clavicle fractures to return to sport sooner than without surgery.

Like anything else, there are drawbacks to surgery – hardware irritation, need for plate removal, numbness around incision, infection, and the scar itself. 

I tend to decide whether to fix a clavicle fracture based on individual patient needs – if the fracture is displaced and in an athlete, I recommend surgery. If not an athlete (or patient with lots of medical problems), I recommend no surgery – risk of surgery not worth it.


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