Should Surgery Be Considered for Displaced Clavicle Fractures?

Is surgery necessary for a displaced clavicle fracture with bone prominence?

Hello Doctor: On August 16th of last month, I was involved in a traffic accident while taking a bus, which resulted in a fracture of my left clavicle after landing on my shoulder.
At that time, my left arm was extremely painful, and I couldn't lift it, with a noticeable bone protrusion.
After being taken to the hospital, an X-ray revealed that the midshaft of my clavicle was completely fractured and displaced.
The doctor briefly explained the fracture situation and mentioned that surgery might be necessary, along with the possibility of deformity.
However, they only applied a sling for stabilization and did not perform any reduction or realignment of the bone.
During my follow-up appointment two days later, the doctor did not provide any further information and simply told me to rest at home.

One month later, during my third X-ray, I noticed that the position of the bone had not significantly changed, which raised my concern that the bone might not have healed at all.
Subsequently, I showed the X-ray images to my roommate's orthopedic surgeon, who stated that surgery was necessary; otherwise, the bone would only grow but not heal, potentially leading to disability.
He also mentioned that the misalignment should have been addressed initially, indicating that the past month had been wasted.
This has caused me considerable worry, prompting me to schedule an appointment at another hospital to determine if surgery is needed.

Therefore, I would like to ask if the initial decision not to perform reduction was a medical error.
Currently, I can move my arm and lift it upwards, but the bone protrusion remains unchanged compared to before.
Given this situation with the protruding clavicle fracture, would it be better to proceed directly with surgery? Thank you.

Wing, 20~29 year old female. Ask Date: 2021/09/17

Dr. Shi Guozheng reply Orthopedics

Clavicle fractures can heal with conservative treatment without surgery.
Traditionally, most clavicle fractures are treated non-operatively.
However, due to advancements in plates and screws, some physicians have adopted a more aggressive approach, opting for surgical intervention.
Both methods can yield similar outcomes, but surgical treatment typically allows for a faster recovery.
It is important to note that surgery may require a subsequent procedure to remove the hardware.
Communicating with your physician before the surgery is crucial.

Reply Date: 2021/09/17

More Info

When considering whether surgery should be performed for displaced clavicle fractures, several factors come into play, including the degree of displacement, the patient's age, activity level, and overall health. In your case, it appears that you have a complete fracture of the midshaft of the clavicle with significant displacement, which can lead to complications if not addressed appropriately.

Clavicle fractures are common, especially in younger individuals and those involved in sports or accidents. The treatment approach can vary based on the fracture's characteristics. Non-surgical management is often sufficient for non-displaced or minimally displaced fractures, where the bone fragments are still aligned and stable. However, in cases of significant displacement, as you described, surgical intervention may be necessary to ensure proper healing and alignment.

The primary goal of surgery for a displaced clavicle fracture is to realign the bone fragments and stabilize them, allowing for optimal healing. This is typically achieved through the use of plates and screws or intramedullary devices. Surgery can help prevent complications such as malunion (improper healing) or nonunion (failure to heal), which can lead to chronic pain, functional impairment, and cosmetic deformity.

In your situation, since you have been experiencing persistent displacement and the bone has not shown signs of healing after one month, it is reasonable to consider surgical intervention. The concern raised by your roommate's orthopedic surgeon about the risk of permanent disability if the fracture is left untreated is valid. If the bone continues to heal in a displaced position, it may lead to functional limitations and discomfort in the long term.

Regarding the initial management of your fracture, it is essential to understand that treatment decisions can vary among healthcare providers based on their clinical judgment and the specific circumstances of the injury. While some practitioners may opt for conservative management initially, others may recommend surgery sooner, especially in cases of significant displacement. If you feel that your initial treatment was inadequate, it is important to discuss your concerns with your current healthcare provider and seek a second opinion if necessary.

In terms of your current symptoms, the fact that you can move your arm and lift it is a positive sign, but the persistent deformity and lack of healing are concerning. Surgery may not only improve the alignment of your clavicle but also enhance your functional recovery and reduce the risk of long-term complications.

In conclusion, given the nature of your clavicle fracture and the lack of healing observed on X-ray, surgical intervention should be strongly considered. It is crucial to have a thorough discussion with your orthopedic surgeon about the risks and benefits of surgery, as well as the potential outcomes based on your specific situation. Early intervention can lead to better functional recovery and a lower risk of complications, allowing you to return to your normal activities with confidence.

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