Adult Clavicle Fractures
A Patient’s Guide to Adult Clavicle Fractures
Signs and Symptoms
A fracture of the clavicle causes pain and swelling in the collarbone area. You will probably not be able to raise the arm. There is usually bleeding into the tissues around the fracture. After several days, there may be intense purple bruising (ecchymosis) around the shoulder and down the arm. This is to be expected and you should not necessarily be alarmed. Swelling may occur from the shoulder to the hand. You may feel the bone fragments shift as you move and should not be alarmed if this occurs. You may be able to see the end of one or more fracture fragments pushing outward and stretching (tenting) the skin. In some cases the fracture fragment may pierce the skin, turning the fracture into an open fracture (also called acompound fracture).
Most clavicle fractures are treated without surgery. The fracture pattern will largely determine whether your surgeon will suggest treating the fracture with or without surgery. Most clavicle fractures occur in the middle third of the bone. These have an excellent chance of healing without surgery. Fractures at the end of the bone near the shoulder are more complicated because of the AC joint and the coracoclavicular ligaments that connect the clavicle to the scapula. Fractures in this area may require surgery. If the fracture is open, meaning there is a laceration that connects with the fracture, surgery is required to cleanse the fracture fragments and reduce the risk of infection.
Some clavicle fractures may need surgery. If your provider makes the assessment that the fracture will NOT heal and give you good shoulder function without surgery, surgical treatment will be recommended. Surgical treatment of clavicle fractures is usually performed two ways: a long metal screw inside the bone or a metal plate and screws along the side of the bone.
Nearly all fractures can result in damage to nerves and blood vessels, but this is an uncommon complication of clavicle fractures. Large nerves and blood vessels travel beneath the clavicle to the arm and hand. Severe injuries to the shoulder girdle that involve a fracture of the clavicle can injure these nerves and blood vessels.
Infection is possible following any surgical procedure used to treat a fracture, but the risk is very low – less than one in a hundred. The risk is much higher if the fracture is a open fracture. An infection following surgery to repair a fracture may require additional surgery to remove the infected tissue and treatment with antibiotics.
The fracture fragments may fail to heal; this is referred to as a nonunion. The fracture fragments may also heal in an unacceptable alignment; this is called malunion. Both of these complications may result in pain, loss of strength, and a decreased range of motion of the shoulder. A second operation may be needed to treat the complication.
Most clavicle fractures heal in about three months. During the first two to three weeks, you may feel the fracture fragments shift as you move your arm. This is normal for fractures that have not been treated with surgery. Your rehabilitation exercises will begin as soon as you can tolerate motion with very gentle exercises (pendulum exercises) designed to regain motion. Once the fracture has healed enough strengthening exercises will be added to your rehabilitation program. This my occur at six to eight weeks. If surgery has been required, the rehabilitation program will be modified to protect the fixation of the fracture fragments. Your surgeon will communicate with your physical therapist to make sure that your rehabilitation program does not risk causing the fixation to fail. If the surgeon feels that the fixation is very solid, you may be able progress your program quickly; if the fixation is not so solid, the speed at which you progress may need to be slowed until more healing occurs.
*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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