How to Choose Broken Collarbone Treatment

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Choose Broken Collarbone Treatment
Choose Broken Collarbone Treatment (Image: http://anniebarryzed.com/accident/, www.medscape.com)

Discover all your options! Broken collarbones (clavicles) are surprisingly common; at the right angle of impact, they're devilishly easy to snap. Luckily they are one of the fastest bones to heal and don't need a cast so they're a cinch to heal, right?? Actually, breaking your collarbone can have damaging long-term impacts, so reading up on all of your treatment options is an important first step to a complication-free future. Most doctors simply send you home with a sling, so it's up to you to do the research to get your bone healed right.

--X-RAY-- Get your hands on an x-ray of your collarbone. Take a cell phone photo of your x-ray at the hospital or orthopedic clinic if you have to.

--TYPE OF FRACTURE-- What kind of fracture do you have? A hairline fracture just has a crack in the bone and the bone is still in one piece. A simple fracture is where the bone is in two and only two pieces. A multiple fracture has the bone in more than two pieces. A compound fracture is where a piece of the bone broke through the skin at some point. (Note that the bone often reenters the body after piercing the skin, so look for a puncture or cut at the break site.)

Multiple fracture
Multiple fracture

--SLING-- Will a sling work for you? Slings work extremely well with hairline fractures, moderately well for simple fractures with little overlap of the pieces, poorly for multiple fractures, and should NOT be used for compound fractures (as there is a high chance the bone became contaminated and needs surgical cleaning.) If you have a compound fracture, skip to step 7.

Standard sling treatment
Standard sling treatment

--FIGURE-OF-8 BRACE-- If you are considering a sling, also consider the figure-of-8 brace, show at left, especially if: (1) Your break is fresh--preferably less than one week old (2) Your livelihood depends upon manual labor or physical use of the shoulder on the side of your fracture (3) Surgery is undesirable due to the financial burden. It is best at forcing your clavicle into a well-aligned position, and although it is less comfortable, it can be WELL worth it.

Back view of figure-of-8 brace
Back view of figure-of-8 brace

--6 WEEK TREATMENT-- If you chose either the sling or figure-of-8 brace, use it consistently for at least six weeks and avoid any motions or lifting that cause any pain or involve moving your elbow out away from your side. Ending treatment early can cause incomplete healing and chronic pain. Enjoy sharing knowing glances and smiles with all the strangers you meet on crutches/in a sling/cast during this period.

--FOLLOW UP-- Return to a doctor to get follow-up x-rays of your collarbone. If it healed in a nice, aligned position, congrats! You're lucky! Skip to step 9 for rehab. If the collarbone healed but the two ends of the bone are overlapping, especially if by more than 1/2", go to the next step. Also, if the two ends of the bone healed poorly or not at all ("disunion" or "malunion" of the bone) go to the next step.

--SURGERY-- It's time to talk surgery (immediately if it's compound.) There are two main types of surgery: a plate screwed onto the bone (especially for multiple fractures) or a pin inserted lengthwise into the bone (especially for simple fractures.) The plate treatment is more common but creates a much longer and more visible scar. If your livelihood depends upon your appearance (model/actor/actress/gold digger) it is recommended you use the pin method.

Clavicle plate and screws
Clavicle plate and screws

--POST-OP-- After surgery, keep the arm in a sling for several weeks. Even as the swelling and pain decrease, try to baby your collarbone; a complete and full recovery will help ensure a pain-free long-term. Follow your doctor's orders; your bone should be fully healed after 12 weeks at the most but you will be able to slowly increase activity starting soon after surgery.

--REHAB-- After your long recovery, your strength and range of motion in the applicable arm will have decreased significantly. Find a GRADUAL rehabilitation program that fits you (either through your doctor or online.) A basic rehab routine to get you started is listed under resources.

Tips & Warnings

  • For non-compound fractures, it is usually worthwhile to FIRST try using a sling or figure-of-8 brace first as it is extremely inexpensive ~($20) compared to surgery ~($2,000-$20,000) and surgery can be successfully done even years down the road. For best results, however, seek treatment immediately.
  • Due to the dangerous risks of infection, compound fractures almost always need surgery.
  • For fresh simple and multiple fractures in which the ends of the bone overlap slightly instead of being aligned, it is highly encouraged that you use the "figure-of-8" brace shown in step 4. The figure-of-8 brace is much less comfortable than a sling but for a good reason: slings encourage hunched posture and the fracture heals with the bones overlapping instead of aligned. In the short term this is more comfortable but in the long term it can cause serious chronic pain as the resulting shortened collarbone creates many other skeletal imbalances. With quick action, a figure-of-8 brace may give you surgery-quality alignment in the bone by forcing yourself to sit with your shoulders back and collarbone at full length.
  • Remember: if you cannot afford surgery, it is HIGHLY recommended that you use a figure-of-8 strap instead of a sling for the best lifelong results.
  • If you lost some feeling in your skin in the area of the break due to surgery or other mild nerve damage, rebuild soft tissue in the area of the clavicle through reasonable strength training routines once your bone has healed. This will bring extra blood flow to the region and help reconstruct the area's sensory nerves, which in most cases are completely repaired in 12-18 months.
  • Your doctor may not even mention surgery as an option unless there is a compound fracture, but surgery is becoming an increasingly accepted option as the long-term benefits are significant (see resources for interesting study). You may need to travel out of your region to find an orthopedic surgeon competent in this surgery.
  • If you choose the pin surgery, your surgeon will most likely recommend leaving the pin in forever as it's difficult to retrieve and very unobtrusive.
  • If you choose the plate and screws surgery, you may leave your plate in or have another surgery (less expensive) to have it removed. If you have a light frame, the plate may cause the area to become tender and it's recommended to have the plate removed about a year later. Beware that removing the plate requires unscrewing several screws and there is a slight chance of the clavicle re-breaking at a screw hole before it re-heals. I know this from personal experience and had to repeat the surgery process as a result. Even so, I don't regret my choice to pursue surgical intervention.
  • Since most people do not have a medscape.com login, I will provide essential excerpts from the study listed under resources. "There have been studies reporting a high dissatisfaction rate with outcomes of the nonoperative treatment of clavicle fractures.[1,2] In addition, there have been advances made in the fixation of clavicle fractures, including anatomic precontoured plates, locking plates, and intramedullary rods. As a result, there has been a renewed interest in fixing clavicle fractures in order to allow for early return to activities and to obtain higher patient satisfaction....The study authors compared patient-oriented outcomes scores following nonoperative vs operative treatment of displaced midshaft clavicle fractures. The patients were randomized through a sealed envelope. Nonoperative treatment was with a sling. The sling was continued until the patients' symptoms resolved. The operative patients were treated with open reduction and internal fixation with small fragment plates and screws....Complications in the nonoperative group included a patient with reflex sympathetic dystrophy, 2 with symptomatic malunions, and 6 patients with nonunions requiring open reduction internal fixation. In the operative group, 2 patients complained of plate irritation and 1 patient had a late wound dehiscence. The study authors concluded that operative treatment provided statistically significant clinical and functional improvement over nonoperative treatment of displaced midshaft clavicle fractures."
  • I'm not a doctor and my advice should not be treated as if I were one. Use this advice at your own risk. By using any of my recommendations, you understand that my qualifications are entirely limited to the following: I've broken my collar bone twice, tried to heal my collarbone using a sling once, had two surgeries each for the purpose of inserting a plate into my collarbone, had one surgery to remove a plate from my collarbone, and have had countless x-rays taken and discussed thoroughly at my multitude of doctor visits.
  • A collarbone that does not heal well or fully on its own is often left "as is" BUT long term it will likely cause back and shoulder problems as it will make your body asymmetrical.
  • Doing a Google Image search for "clavicle fracture" and other related terms can bring up some gross pictures...beware! : )

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