Clavicle Fractures: Recovery, Treatment, and Rehabilitation

Clavicular closed fracture

Hello Doctor: I was involved in a car accident on December 4th, which resulted in a closed fracture of my right clavicle (located near the end connecting to the arm).
The doctor said that surgery was not necessary, and I was discharged with a sling.
During my follow-up appointment on December 7th, the doctor mentioned that it was not possible to determine displacement from the X-ray alone, and that surgery was an option, but I ultimately chose not to have surgery.
It has now been a week since the accident, and there is little pain at the injury site.
I would like to ask the doctor: 1.
How long should I wear the sling? Is there a specific duration that I must adhere to before I can remove it, or can I take it off at any time? 2.
Before showering, when I remove the sling and try to extend my arm, it feels tight and slightly painful.
Is this normal, or could it indicate ligament injury as well? 3.
With a non-surgical treatment approach, even if the bone has healed, could any misalignment affect future function and range of motion? 4.
Since it has been a week since the injury, are there any light rehabilitation exercises that I can start doing? Thank you for your patience in answering my questions.

Ms. Chen, 20~29 year old female. Ask Date: 2016/12/11

Dr. Shi Guozheng reply Orthopedics

It is best to keep the triangular bandage on for three months and avoid frequently removing it.
The ligament may not necessarily be injured; if it heals completely, there should be no impact on function and range of motion.
After about two weeks, pendulum exercises with the arm hanging down can be performed.

Reply Date: 2016/12/11

More Info

Understanding clavicle fractures, particularly in the context of your recent accident, is crucial for ensuring proper recovery and rehabilitation. Clavicle fractures are common injuries, especially in traumatic events like car accidents, and they can significantly impact shoulder function if not managed correctly.

1. Duration of Sling Use: After a clavicle fracture, the use of a sling is typically recommended to immobilize the shoulder and allow for healing. Generally, a sling should be worn for about 3 to 6 weeks, depending on the severity of the fracture and the doctor's recommendations. It is essential to follow your physician's advice regarding the duration of sling use. Removing the sling too early can lead to complications, including improper healing or displacement of the fracture.

2. Pain and Tightness When Removing the Sling: It is not uncommon to experience tightness or mild pain when you first remove the sling, especially if you have not moved your arm for several days. This sensation can be attributed to muscle stiffness and the body's natural response to immobilization. However, if the pain is severe or if you notice swelling or bruising, it may indicate additional injury, such as a ligament strain or injury. It is advisable to consult your physician if you have concerns about the level of pain or tightness.

3. Impact of Non-Surgical Treatment on Functionality: If the fracture is not displaced and healing progresses well, non-surgical treatment can be effective. However, if there is any misalignment (malunion) due to the fracture not being properly aligned, it could lead to long-term functional issues, such as limited range of motion or chronic pain. In some cases, if the bone heals in a misaligned position, surgical intervention may be necessary later to correct the alignment and restore function.

4. Initiating Rehabilitation Exercises: After a week of immobilization, gentle rehabilitation exercises can often be introduced, but this should be done cautiously and ideally under the guidance of a physical therapist. Initial exercises may include passive range-of-motion exercises, where you gently move your arm without using the muscles actively. These exercises can help prevent stiffness and maintain some mobility in the shoulder joint. As healing progresses, more active exercises can be incorporated to strengthen the muscles around the shoulder and improve function.

In summary, while your initial recovery seems promising with reduced pain, it is essential to adhere to your doctor's recommendations regarding sling use and rehabilitation. Regular follow-up appointments are crucial to monitor the healing process through X-rays and clinical assessments. If you experience any unusual symptoms or have concerns about your recovery, do not hesitate to reach out to your healthcare provider. They can provide personalized advice and adjust your treatment plan as necessary to ensure optimal recovery and functionality of your shoulder.

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