Clavicle Fractures: Recovery Challenges and Surgical Options

Fracture

I had a car accident at the end of March, resulting in a fracture of my left clavicle near the shoulder.
I did not undergo surgery and used a figure-eight shoulder strap for one month.
After that, I went to a military hospital for an X-ray, which showed some bone growth.
However, after another half month, the bone was protruding and pressing against the skin.
I then visited a physician at Tai-An Hospital, who recommended surgery to cut the bone.
Now, a month later, during a follow-up visit and X-ray, it was observed that one segment of the bone is positioned downward while another segment is upward.
The doctor advised that I need to protect the area.
Currently, my clavicle is very prominent and enlarged, and I am unable to lift my arm.
I am experiencing muscle atrophy, my scapula is protruding, and I have back pain with my shoulder appearing uneven compared to the right side.
Please help me.
0987534425

Lu, 30~39 year old female. Ask Date: 2009/07/01

Dr. Chen Xingyuan reply Orthopedics

Dear Reader,
The treatment for clavicle fractures can be divided into conservative treatment and surgical treatment.
Surgical intervention is necessary in cases of open fractures, associated neurovascular injuries, mid-shaft clavicle fractures with significant displacement, fractures with ends nearly penetrating the skin, displaced distal clavicle fractures, and multiple fractures occurring simultaneously.
Additionally, the patient's pain tolerance and cooperation are important factors to consider.
Generally, the benefits of surgery include immediate reduction and stabilization of the fracture, which can reduce the duration of pain and allow for earlier initiation of shoulder rehabilitation activities.
However, this comes with various surgical risks.
If conservative treatment is chosen, a figure-of-eight shoulder brace is typically used for six weeks along with more frequent X-ray follow-ups, which can also yield good results.
Usually, for mid-shaft clavicle fractures without significant displacement, if the patient has a good pain tolerance and is cooperative, conservative treatment is recommended, with over 80% achieving excellent healing.
Regardless of whether conservative or surgical treatment is chosen, shoulder rehabilitation exercises are crucial and should ideally begin as soon as possible.
Initially, assistance from the uninjured arm or another person may be needed to lift the arm, with the lifting angle based on the patient's pain tolerance and ensuring no sound is produced at the fracture site.
The goal is to achieve full arm elevation within four weeks.
You have been injured for 3 to 4 months, and currently, the range of motion in your shoulder does not seem ideal, with signs of muscle atrophy.
It is now necessary to determine if there is any issue with fracture healing (you may request your attending physician to perform follow-up X-rays).
However, the most important aspect is to engage in active rehabilitation therapy to restore shoulder joint mobility and muscle strength as soon as possible.
Wishing you safety and success!
Sincerely,
Dr.
Chen

Reply Date: 2009/07/01

More Info

Clavicle fractures are common injuries, particularly in trauma cases such as car accidents. The clavicle, or collarbone, connects the arm to the body and plays a crucial role in shoulder function. Recovery from a clavicle fracture can be challenging, especially when surgical intervention is required. In your case, it seems that you have experienced a series of complications that are not uncommon with this type of injury.

Recovery Challenges
1. Bone Healing: The clavicle typically heals well due to its rich blood supply, but complications can arise. In your situation, the bone has not healed properly, leading to a malunion where the bone fragments are misaligned. This can cause discomfort and functional limitations, such as difficulty lifting your arm.

2. Muscle Atrophy: After a fracture, especially when immobilized for an extended period, muscle atrophy can occur. This is particularly concerning in the shoulder and upper arm muscles, which may lead to weakness and decreased range of motion.

3. Postural Changes: The protrusion of the clavicle and the shoulder blade can lead to postural issues, causing discomfort and pain in the back and neck. This is often exacerbated by compensatory movements that the body adopts to avoid pain.

4. Pain Management: Chronic pain can be a significant issue following a clavicle fracture, especially if there is nerve involvement or if the bone is impinging on surrounding tissues.

Surgical Options
Given the complications you've described, surgical intervention may be necessary to realign the bone and alleviate symptoms. Here are some surgical options that may be considered:
1. Open Reduction and Internal Fixation (ORIF): This procedure involves surgically realigning the fractured bone and securing it with plates and screws. This method is often preferred for displaced fractures, as it allows for better alignment and stability.

2. Bone Grafting: If there is significant bone loss or if the bone is not healing properly, a bone graft may be necessary. This involves taking bone from another part of your body or using synthetic materials to promote healing.

3. Reconstructive Surgery: In cases of malunion or nonunion, reconstructive surgery may be needed to correct the alignment of the clavicle and restore function.

Rehabilitation
Post-surgery, a structured rehabilitation program is crucial for recovery. Here are some key components:
1. Physical Therapy: Engaging in physical therapy can help restore range of motion, strength, and function. A therapist can design a program tailored to your specific needs, focusing on gentle stretching and strengthening exercises.

2. Gradual Increase in Activity: It’s essential to gradually increase your activity level. Start with passive movements and progress to active exercises as tolerated.
3. Pain Management: Managing pain effectively is vital for participating in rehabilitation. This may involve medications, ice therapy, or other modalities as recommended by your healthcare provider.

4. Monitoring Progress: Regular follow-ups with your orthopedic surgeon are essential to monitor the healing process and make any necessary adjustments to your treatment plan.

Conclusion
Clavicle fractures can lead to significant challenges in recovery, particularly when complications arise. It’s essential to work closely with your healthcare team to develop a comprehensive treatment and rehabilitation plan tailored to your specific situation. This will help ensure the best possible outcome and restore your shoulder function. If you have concerns about your current treatment or recovery, don’t hesitate to discuss them with your orthopedic surgeon or physical therapist. They can provide guidance and support to help you navigate this challenging recovery process.

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