Shoulder Surgery

Broken Collarbone Surgery

Clavicle fracture surgery (broken collarbone)

Collarbone fractures are very common and in most cases can be managed without surgery. When surgery is indicated, it requires careful planning, meticulous surgical fracture fixation and close follow up with guided rehabilitation. Patients stay in hospital overnight and wear a sling for 6 weeks; strengthening is commenced at 3 months postoperatively. Surgery is able to produce a more reliable outcome for younger patients and for those who work overhead or in a manual capacity.  

 

These are the types of patients who should consider surgery to fix a broken collarbone (fractured clavicle):

  • Displaced fracture (fracture fragments further away)
  • Comminuted fracture with a Z type deformity (fracture in many pieces)
  • Manual occupation (especially overhead and lifting)
  • High-level athletes or sports persons (particularly overhead)
  • Those who are unable to manage their pain
  • Those who live alone or care for others and need to restore their function as soon as possible

The decision to proceed with the surgery is unique to each individual and based on the collarbone fracture pattern, social/work circumstances and expectations.

The goal of clavicle fracture surgery is to obtain anatomical reduction and stable fixation to allow an early range of motion and return to full function in a timely manner.

The surgery to fix a broken collarbone (fractured clavicle) is called: Open Reduction and Internal Fixation (ORIF)

Open reduction means that the fracture site is exposed with an incision and the fragments of bone are reduced into anatomical position. Internal fixation means that plates and screws are used to stabilise the fracture.

  • The procedure is performed under a General Anaesthetic where you will be positioned on your back
  • Using the pre-operative x-rays the fracture pattern is carefully analysed and the operation planned accordingly
  • A 7-10cm incision is made over the clavicle and the fracture carefully identified
  • Often the fracture is in multiple pieces and each of the fragments is mobilised and repaired using screws and a plate.
  • X-rays are taken at the end of the operation and the wound is closed in layers. A waterproof dressing is then applied and your arm is placed in a sling.
  • JPL rehabilitation program is commenced from 2 weeks post-surgery
  • Dr Pant will then organise close follow up at regular intervals and liaise with your Physiotherapist to maximise your recovery.
  • Regular follow up is organised and full contact can be commenced in most cases at 3 months post-surgery.

A series of 2 medical diagrams showing the preparation for broken collarbone surgery

A medical diagram showing the stable fixation with plate a multiples screws use to treat a broken collarbone anatomically

Most patients report a sense of “relief” after their collarbone is fixed and can commence light activity with the operated arm (such as self-care, feeding, and using a mobile phone) immediately.

There are three essential components to a good outcome from surgery:

  • Your surgeon
  • You as a patient
  • Your physiotherapist.

Post-operative physiotherapy

Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery; it will be modified to suit your individual circumstance.

The JPL pathway allows for self-directed, early passive shoulder range of movement:

  • Passive = assisted with your other arm
  • Active = you move the affected arm independently

A sling is required for the first 6 weeks after your surgery – at which point most patients have a full range of motion in the shoulder.

Therapy overview 

After the surgery you will be in a sling and protect your shoulder to allow the collarbone to heal. At two weeks after the surgery Dr Pant will see you at your review appointment and discuss the JPL rehabilitation protocol with you. This JPL physiotherapy protocol will commence two weeks after your surgery.

The therapy program will focus on flexibility and range of motion exercises initially. These gentle stretches will improve your range of motion and prevent shoulder stiffness. As the fracture begins to heal you will be able to progress to exercises that strengthen your shoulder muscles. Shoulder strengthening exercises are commenced at 12 weeks after broken collarbone surgery. Dr Pant will discuss when it is safe to return to your chosen sports. Generally, collision sports and overhead contact athletes need more time to allow for healing.

Driving after shoulder surgery

  • After shoulder surgery, you will be in a sling and you may be unable to drive for at least 6 weeks
  • This does vary depending on the complexity of your surgery and the patient. Some patients may be able to drive at 2-4 weeks, and some may not be able to drive for the full 12 weeks. This will be individualised to your situation.

Showering and getting dressed

  • You may take the sling off to shower
  • Lean forward and allow your arm to “dangle” to wash under your arms
  • The dressings applied are waterproof and you may shower with them on
  • Usually, before you are discharged from Hospital, your dressings are changed after your morning shower.
  • These “new” dressings are then kept intact until your review at 10-14 days
  • If the dressings start to peel at the edges – you may reinforce them
  • If the dressings discolour with discharge (yellow or green) you may have a wound infection; do not be alarmed just yet – please notify SSU (02 9215 6100 or admin@drpant.com.au) and we will give you a plan.
  • When getting dressed, you may use your good arm to move your affected (operated arm) to place your arms through the sleeves carefully

Sleeping after Shoulder Surgery

  • Most patients find it difficult to lie flat after shoulder surgery.
  • Consider using a few pillows to prop yourself up and sleep at a slight incline; this may be necessary for 4-6 weeks after surgery. You should keep your sling on while asleep.

Elbow and hand movement

  • Keep your elbow and hands joints moving and supple for the duration of time you are in the sling. The best time to move your elbow (into full extension and flexion) is when you are in the shower, just out of the shower and about to get dressed.

General risks of clavicle surgery (broken collarbone)

Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications.

The risk of complications after clavicle fracture surgery is less than 1% in the Sydney Shoulder Unit experience. General risks include:

  • Infection
  • Bleeding
  • Wound healing problems
  • Damage to blood vessels or nerves
  • Sensory changes around the surgical scar

Specific risks relating to clavicle surgery

  • Delay in bone healing (delayed union)
  • Hardware irritation
  • Neurovascular injury during surgery
  • Frozen shoulder

Patients who smoke, use tobacco products, have diabetes, or are elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound and bone healing. Most healthy patients, however, cope well with collarbone surgery and are unlikely to have complications.

The outcome after clavicle fracture (broken collarbone) surgery is excellent; most patients report a feeling of the shoulder being stable the day after surgery, and by two weeks they are back to basic things around the house. At the final follow up visit at 3 months the fracture has usually healed and strengthening is commence. Contact sport is allowed 4-6 months from surgery. The chance of hardware removal in the Sydney Shoulder Unit experience is less than 5%.

Dr Pant has extensive experience fixing broken collarbones and is highly skilled in the surgical repair of all collarbone fractures. As the lead shoulder trauma surgeon at St Vincent’s Hospital for many years, he has experience with a vast array of shoulder and clavicle fractures; and is well versed in guiding you to full recovery.

Patient results

Broken Collarbone – Scooter accident

This 25 year old University Student came off his scooter and fell onto his left shoulder. He presented to the hospital with left shoulder pain and deformity. Plain x-rays demonstrated a comminuted (many parts) and displaced 4 part fractured left clavicle (collarbone). The options were discussed and he opted for surgery.

He underwent an ORIF (Open Reduction and Internal Fixation). We achieved anatomical reduction and stable fixation. Each of the fragments of bone were carefully mobilised and repaired back to the anatomical (normal) position. Immediately after surgery, his collarbone felt stable and he was pain free and comfortable. This is a common story from patients after the “unstable” collarbone is stabilised with surgery. He commenced JPL rehabilitation at 2 weeks and by 6 weeks had full symmetrical range of motion. By 12 weeks he had healed his broken collarbone (both on examination and imaging) and was back to all activities, including his beloved scooter.

Broken Collarbone – Cycling accident

This 29 year old lady fell off her bicycle and landed on her right shoulder. She presented to the hospital immediately with pain and deformity around the right shoulder. Clinically she had a displaced clavicle fracture and this was confirmed on X-ray.

The X-ray demonstrates a complex 3-4 part displaced clavicle fracture; the central fragment is in a few pieces and there appears to be a Z type fracture configuration.

The options were discussed with her – early surgery was recommended given her young age, fracture displacement and fracture comminution/configuration. She elected to proceed with surgery and she underwent Open Reduction and Internal Fixation (ORIF) the following day.

At surgery, we were able to reduce all of the small fragments of bone with separate small screws outside of the plate (2.4mm screws) and then achieve stable fixation with a plate and screws. X-rays taken during surgery confirmed anatomical reduction and stable fixation. She was pain-free the day after surgery and commenced JPL therapy at 2 weeks postoperatively. She went on to heal her fracture at the 3-month X-ray and is back to riding her bicycle (albeit more carefully).

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