Clavicle Fractures: Healing Challenges and Treatment Options

Clavicle fracture

Hello, doctor.
I was in a car accident on November 19, 2017, after 12 PM, where a small car collided with a mountain wall and flipped over.
I was sitting on the far left, and there were two other guys pressing against me.
Everyone else was fine, but I ended up with a fractured collarbone.
I went to a military hospital for emergency care, and the doctor said it was a hairline fracture that didn't require surgery, just a figure-eight shoulder strap for support, and instructed me to return for a follow-up a few days later.
About three days later, the diagnosis stated it was a closed fracture.
During the follow-up, the doctor mentioned that it would take 100 days for the soft tissue and bone to heal.
The pain was manageable at that time, but I could only sleep on my back and wore very loose clothing, trying to avoid moving my right arm.
After a few days, when my medication ran out, I went back for a follow-up with the same doctor.
He said as long as there was no displacement, everything was fine, and he didn't provide much additional information, just prescribed more medication and let me go.
When my follow-up appointment came up again, I saw a different doctor who said it would take three to six months, and I should avoid lifting anything heavy or raising my arm, as atrophy could occur.
He told me to return in a month.
By that time, I was already able to move around comfortably and could turn over while sleeping, but I only dared to turn to the side without the fracture.
I could also slowly pick up small items.
After a little over a month, I returned, and the same two doctors told me it would take a year for complete healing and mentioned that I could actually remove the shoulder strap.
However, due to concerns about my sense of security, I kept it on.
Generally, as long as I avoid heavy lifting and raising my arm, I don't experience much pain.
I used to have some difficulty with low ponytails and washing dishes, but I felt like there weren't any major issues anymore.
I still hesitated to try sleeping on my side, and every morning I would wake up with soreness in my shoulder, which would go away shortly after waking up.
The doctor only prescribed me some patches, saying there was a slight indication of bone growth.
I forgot the exact term, but I found it strange that it was taking so long.
My family took me to a large hospital in Taichung on January 13, and the doctor there said my bone wasn't healing at all, and the growth was just becoming increasingly rounded and swollen, not hard bone.
He mentioned that the likelihood of this trend was very high, and that the initial assessment of not needing surgery was correct, but my healing time was too slow and was worsening.
He suggested surgery to fix the fracture, or I might be stuck like this for life, and he also mentioned that smoking was slowing down the healing process, but drinking alcohol was not an issue.
He said he was allergic to cigarettes.
I kept insisting that I didn't want surgery, but he said it was unavoidable unless I quit smoking.
How could a doctor say that? What is the situation here? Why are the opinions of the two doctors so drastically different? I was in tears hearing this.
After my injury, I didn't take any supplements, mostly eating street food, and in the days leading up to my visit to Taichung, I had been feeling very down and had a bit of alcohol, but it was hard liquor.
Additionally, I have had severe issues with my sleep schedule for several years due to work, often working at a pub where I drank a lot.
I also have a tendency to develop keloids, and my wound seems to heal unusually slowly; while others' scrapes heal in a week, mine take over a month.
Is this related to my body type, or is it really as serious as that doctor said? Which doctor's advice should I trust? My arm hardly hurts, but I'm still afraid to make big movements or lift anything high, and I'm worried about scarring and pain, so I don't want surgery.
Doctor, what do you suggest?

QQ, 20~29 year old female. Ask Date: 2018/01/13

Dr. Shi Guozheng reply Orthopedics

If a clavicle fracture is treated conservatively, there is a high chance of gradual healing with callus formation within approximately three months.
If pain persists beyond three months and there are no signs of callus formation, surgical intervention should be considered.
Since you are currently two months post-injury, it may be advisable to wait and observe further.

Reply Date: 2018/01/13

More Info

Clavicle fractures, commonly known as collarbone fractures, are a prevalent injury, especially in cases of trauma such as car accidents. The management of these fractures can vary significantly based on the type and severity of the fracture, as well as the individual patient's circumstances.
From your description, it appears that you initially received conservative treatment for your clavicle fracture, which is often the standard approach for non-displaced or minimally displaced fractures. The use of a figure-of-eight brace is a common method to immobilize the area and promote healing. Generally, clavicle fractures have a high healing rate, with studies indicating that around 95% of these fractures heal well without surgical intervention, provided there is no significant displacement.

However, your experience of prolonged healing and the differing opinions from various healthcare providers raises some important considerations. The fact that one physician indicated that your bone was not healing properly and suggested surgical intervention is concerning. Surgical options, such as internal fixation with plates and screws, may be necessary if the fracture is not healing adequately or if there is significant displacement that could lead to complications.

Several factors can influence the healing of fractures, including age, overall health, lifestyle choices (such as smoking), and the nature of the fracture itself. Smoking, in particular, has been shown to impair bone healing due to reduced blood flow and oxygenation to the healing tissues. If you are a smoker, this could indeed be a contributing factor to your delayed healing process.

Additionally, your mention of a history of delayed wound healing (as indicated by your skin condition) could also play a role in your recovery from the fracture. Conditions like keloid formation (crab foot syndrome) can affect how your body heals, and it is essential to communicate this history to your healthcare providers.

The discrepancy between the opinions of the two doctors you consulted could stem from differences in their assessment of your X-rays, your clinical presentation, or their treatment philosophies. It is not uncommon for medical professionals to have varying opinions on the necessity of surgery, especially in cases where the healing process is not straightforward.

Given your concerns about pain, mobility, and the potential for long-term complications, it is crucial to seek a second opinion from an orthopedic specialist who has experience with clavicle fractures. They may recommend imaging studies, such as a CT scan or MRI, to better assess the healing status of your clavicle and determine if surgical intervention is warranted.

In the meantime, it is advisable to follow the conservative management plan as much as possible, avoiding activities that could exacerbate your injury. Engaging in physical therapy may also be beneficial to improve your range of motion and strength as you heal.
In conclusion, while many clavicle fractures heal well with conservative treatment, your situation may require a more tailored approach. Addressing lifestyle factors, seeking further medical evaluation, and possibly considering surgical options could all be part of your path to recovery. Remember, open communication with your healthcare providers about your concerns and symptoms is vital in navigating your treatment effectively.

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