Partial Clavicle Healing After Fracture: What to Do Next?

Clavicle fracture, with partial bone healing?

Hello! I was in a car accident and fractured my left clavicle (midshaft location).
The fracture ends are significantly displaced.
I did not undergo surgery.
Each time I visited the doctor (I have seen him four times), he said, "This is healing well, no problems, don't worry, just wait for it to heal on its own!" This has been going on for 2.5 months.
A few days ago, I went for a follow-up appointment and had an X-ray taken.
It showed that the lower part has healed quite a bit, but the upper part has not shown any growth.
This time, the doctor (the same one) suddenly said, "Did you know that the first two months after a fracture are the golden period for bone healing? You have already missed it, and now it may or may not grow further." I was taken aback.

I have a few questions:
1.
Why is only part of the bone growing? (If it were an issue with my body, both parts should not be growing.
If my movements caused the bones not to align, then they should not be healing at all.
How can one part grow while the other does not?)
2.
Is it possible that the bone will stop growing as a result of this?
3.
What should I do? (Currently, the fracture site occasionally hurts a little.
My left shoulder, scapula, and neck are tight and sore due to lack of movement.) Additionally, to expedite rehabilitation, I have been doing heat therapy at another orthopedic clinic, where the physician advised that I should start moving my arm and shoulder quickly to avoid adhesions, or I may have issues with movement in the future.
I am really unsure whose advice to follow! Thank you!

Mr. Chen, 50~59 year old female. Ask Date: 2015/02/08

Dr. Hong Ximing reply Orthopedics

Midshaft clavicle fractures typically heal with figure-of-eight bandaging.
If there is significant displacement, consideration should be given to surrounding soft tissue entrapment, which may lead to delayed or poor healing.
If healing is inadequate, surgical intervention should be considered.
Rehabilitation should allow for early mobilization, with the recommendation to avoid raising the arm above shoulder level for the first four weeks.
Further details should be discussed with the attending physician.

Reply Date: 2015/02/08

More Info

Understanding the healing process of a fractured clavicle can be quite complex, especially when complications arise. In your case, it seems you have experienced a significant injury with a midshaft clavicle fracture that has not healed as expected. Let's address your concerns one by one.

1. Why is only part of the bone healing?
Bone healing can be influenced by several factors, including the type and location of the fracture, the stability of the fracture site, and individual biological factors such as age, nutrition, and overall health. In your situation, the fact that the lower part of the clavicle is healing while the upper part is not could be due to inadequate stabilization of the fracture. If the fracture ends are not properly aligned or if there is excessive movement at the fracture site, it can hinder the healing process. This phenomenon is known as "non-union," where the bone fails to heal completely. It is also possible that the blood supply to the upper fragment is compromised, affecting its ability to heal.

2. Will the bone stop healing altogether?
While it is concerning that the upper part of your clavicle has not shown signs of healing, it does not necessarily mean that it will stop healing completely. Bones can sometimes take longer to heal than expected, and there may still be a chance for the upper fragment to unite over time. However, if there is no significant improvement within a few months, further intervention may be necessary. This could include surgical options such as internal fixation to stabilize the fracture and promote healing.

3. What should you do next?
Given your situation, it is crucial to follow up closely with your orthopedic specialist. If you are experiencing pain and limited mobility, it may be beneficial to seek a second opinion from another orthopedic surgeon, particularly one who specializes in shoulder and clavicle injuries. They can provide a comprehensive evaluation and discuss potential treatment options, including the possibility of surgery if conservative management fails.

In terms of rehabilitation, it is essential to balance rest and activity. While it is important to avoid excessive movement that could disrupt healing, gentle range-of-motion exercises can help prevent stiffness and maintain mobility in your shoulder and neck. It is advisable to follow the guidance of a physical therapist who can tailor a rehabilitation program to your specific needs, ensuring that you do not exacerbate your injury while still promoting healing.

Additionally, consider discussing your concerns about the healing process with your doctor. Ask about the possibility of imaging studies, such as a CT scan, which can provide a more detailed view of the fracture and help assess the healing status. This information can guide the decision-making process regarding further treatment.

In summary, while it is concerning that your clavicle fracture is not healing as expected, there are steps you can take to address the situation. Seek a second opinion, engage in appropriate rehabilitation, and maintain open communication with your healthcare providers to ensure the best possible outcome for your recovery.

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