Clavicle Fractures: Healing, Aesthetics, and Long-Term Effects

Clavicle fracture

Dear Dr.
Shi,
On April 4th, I fractured my clavicle after hitting a guardrail while riding my bike, specifically in the distal third.
After examination, the doctor advised me to wear a figure-eight brace and that it would heal naturally, allowing me to continue normal activities.
However, after a follow-up X-ray on April 9th, it was found that the fracture site has taken on a "V" shape, and there is currently a noticeable protrusion from the outside.
I am concerned whether this bulging will remain after healing, as I am a woman and care about aesthetics.
Will the swelling subside over time? What can I do to make it as symmetrical as possible with my right side? Will this type of fracture lead to any long-term complications?
I have also consulted with a traditional Chinese medicine practitioner, who mentioned that my shoulders might end up uneven in length, the acromion might sink, and muscle atrophy could lead to poor function.
They suggested that I need manual therapy to push the clavicle down and elevate the scapula to prevent severe displacement.
Is this true? I am really worried! I would greatly appreciate your help in answering my concerns.
Thank you very much,
Ms.
Liu

Liu Xiaojie, 20~29 year old female. Ask Date: 2001/04/14

Dr. Shi Guozheng reply Orthopedics

Clavicle fractures can generally be treated non-surgically; however, this method often results in a prominent or slightly deformed healing, and sometimes a slight shortening of the bone.
There are several situations that necessitate surgical intervention, such as open fractures, fractures located in the outer third of the clavicle, fractures with deformed ends pressing against the skin which may cause skin penetration, injuries to nerves or blood vessels, and fractures that have not healed after a certain period.
Some advocate for immediate surgery, citing benefits such as proper fracture alignment, secure fixation, reduced pain duration, and quicker recovery of mobility or return to work.
Traditional Chinese medicine or folk remedies, such as those provided by bone setters or massage, are not recommended.
After a fracture, nearby joints may become hesitant to move due to pain, which can lead to muscle atrophy or impaired joint function; however, this can be overcome by engaging in early movement or rehabilitation therapy.
If there are any concerns, it is important to consult an appropriate physician.

Reply Date: 2001/04/14

More Info

Clavicle fractures, particularly those occurring in the distal third of the bone, are common injuries that can result from falls or direct impacts, such as in your case with the bike accident. The treatment approach often involves conservative management, including the use of a figure-eight brace to stabilize the fracture and allow for natural healing. However, the concerns you have regarding the healing process, aesthetics, and potential long-term effects are valid and deserve thorough discussion.

Healing Process
Clavicle fractures typically heal within 6 to 12 weeks, depending on the severity of the fracture and the individual’s overall health. During this time, the body forms a callus around the fracture site, which eventually hardens into bone. The "V" shape you observed on your X-ray indicates that the fracture may not be aligning perfectly, which can happen in some cases. However, it is important to note that many fractures heal with some degree of angulation, and this does not always lead to functional impairment.

Aesthetic Concerns
Regarding your concerns about aesthetics, it is common for individuals to worry about the appearance of the collarbone post-healing. The prominence of the fracture site can vary based on how well the bone heals and the individual’s body composition. In some cases, the area may appear more pronounced or asymmetrical compared to the uninjured side. While some swelling may persist for a while, it often decreases over time as the healing progresses.

To help with symmetry and aesthetics, physical therapy can be beneficial. A physical therapist can guide you through exercises that strengthen the surrounding muscles and improve posture, which may help in achieving a more balanced appearance. However, it is essential to wait until your doctor gives you the green light to start any rehabilitation exercises.

Long-Term Effects and Complications
As for long-term effects, most individuals with properly managed clavicle fractures do not experience significant complications. However, there are potential issues to be aware of:
1. Nonunion or Malunion: In some cases, the fracture may not heal properly, leading to persistent pain or functional limitations. If the bone heals in a misaligned position (malunion), it may require surgical intervention to correct.

2. Shoulder Function: While it is possible for some individuals to experience shoulder asymmetry or weakness, this is not universally the case. Regular follow-up with your healthcare provider and adherence to rehabilitation can mitigate these risks.

3. Muscle Atrophy: If there is a prolonged period of immobilization, muscle atrophy can occur. Engaging in physical therapy as soon as it is safe can help prevent this.

Concerns About Traditional Treatments
Regarding the advice you received from traditional medicine practitioners about manipulating the clavicle or shoulder blade, it is crucial to approach such treatments with caution. While some alternative therapies can be beneficial, they should not replace conventional medical advice. Manipulating a healing bone can lead to further complications, including displacement or improper healing. Always consult with your orthopedic surgeon or a qualified healthcare provider before pursuing such treatments.

Conclusion
In summary, while your concerns about the healing of your clavicle fracture are understandable, many individuals recover well with appropriate care. The appearance of the collarbone may improve over time, and with the right rehabilitation, you can regain strength and function. It is essential to maintain open communication with your healthcare team and follow their recommendations closely to ensure the best possible outcome. If you have ongoing concerns about aesthetics or functionality, discussing these with your doctor can provide you with tailored advice and reassurance.

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