Clavicle Fracture Healing: When to Move Your Arm Again?

Clavicular long bone callus issue?

Hello, Doctor.
I had a car accident in early May and fractured my left clavicle, which was displaced.
I did not undergo surgery and only used a figure-eight shoulder strap for stabilization.
In early June, while sitting in a taxi, I was hit by a vehicle from behind, causing my left clavicle to fall under the floor mat in the car.
After being sent to the emergency room, the doctor said there was no issue and that surgery was not necessary, so I was advised to continue monitoring.
On June 27, during a follow-up visit, the doctor mentioned that the bone had already formed a callus (it had been eight weeks since the first accident in May), and I could start moving my upper arm at home.
However, after trying to move it, I still felt discomfort and some pain.
The next day, on June 28, I returned to the clinic, and the doctor took another X-ray for comparison, stating that the callus had not yet formed.
Given that I had two accidents (it had been three weeks since the second accident in early June), he indicated that the callus should form a lump around the fracture site, so I was advised to continue wearing the figure-eight shoulder strap and not to move my upper arm.
The opinions of the two doctors differ significantly.
When will the callus form? What does it mean for it to be "healed"? What does "stuck together" mean? Do I need to continue wearing the figure-eight shoulder strap? Can I move my upper arm now? Thank you for your response, and I appreciate it.
I have attached the X-rays from June 27 and June 28: https://drive.google.com/drive/folders/0B_RVuHfYRLhIc19vSDZ5NVVVMVU?usp=sharing Thank you.

A-Yan, 40~49 year old female. Ask Date: 2017/06/29

Dr. Shi Guozheng reply Orthopedics

A clavicle fracture, if not surgically treated, will gradually heal with callus formation, which typically takes about three months.
Initially, the bone will grow back, but its strength will not be sufficient, so it is essential to wait until it is fully healed before engaging in vigorous activities.
A brace should ideally be worn for three months.
Range of motion exercises for the upper arm can begin after two months, but if significant force is required, it is still necessary to wait until the bone has completely healed.

Reply Date: 2017/06/29

More Info

Understanding the healing process of a clavicle fracture can be complex, especially when there are multiple factors at play, such as the nature of the injury, the treatment method, and any subsequent trauma. Based on your situation, it appears that you have experienced a left clavicle fracture that was initially treated conservatively with a figure-eight shoulder strap. After a second incident, you were reassured that surgery was not necessary, but there seems to be some confusion regarding the healing status of your fracture.

Firstly, it’s important to clarify what is meant by "bone healing" and the terms used in this context. When a bone fractures, the body initiates a healing process that involves several stages: inflammation, repair, and remodeling. During the repair phase, a soft callus forms around the fracture site, which eventually hardens into a bony callus. This process typically takes several weeks to months, depending on various factors, including the type of fracture, the patient’s age, nutritional status, and overall health.

In your case, the first doctor indicated that you had developed a bony callus by the time of your follow-up appointment on June 27, which is approximately eight weeks post-injury. However, the second doctor’s assessment suggested that the fracture had not yet healed adequately, leading to the recommendation to continue using the figure-eight strap and to avoid moving your arm. This discrepancy can be frustrating, but it highlights the variability in healing times and the subjective nature of interpreting X-rays.

The term "bone callus" refers to the new bone tissue that forms around the fracture site as part of the healing process. When a doctor says that the bone has "stuck" or "healed," they typically mean that the fracture ends are aligned and that there is sufficient callus formation to stabilize the fracture. However, this does not always mean that full range of motion or strength is restored immediately.

As for when you can start moving your arm again, this largely depends on the healing status of your fracture. Generally, once a fracture has formed a stable callus and is no longer at risk of re-fracturing, gentle range-of-motion exercises can be introduced. However, if there is still pain or a feeling of instability, it is advisable to continue immobilization until you receive a clear indication from your healthcare provider that it is safe to proceed.

In your case, since you are still experiencing discomfort and the second doctor advised against moving your arm, it would be prudent to follow that guidance. Continuing to wear the figure-eight strap may help provide the necessary support to ensure that the fracture heals properly without further complications.

In summary, the healing of a clavicle fracture can take time, and it is essential to follow your healthcare provider's recommendations closely. If you have concerns about the differing opinions from your doctors, consider seeking a third opinion or asking for a referral to an orthopedic specialist who can provide a more comprehensive evaluation of your situation. Regular follow-up appointments and imaging studies (like X-rays) will help monitor the healing process and guide your rehabilitation. Remember, patience is key in the recovery process, and prioritizing proper healing will ultimately lead to better outcomes in the long run.

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