Clavicle Fractures: Treatment Options and Recovery Concerns

Clavicle fracture

Dear Doctor,
I would like to ask a question regarding my condition.
I was in a car accident on the afternoon of August 22, and I experienced significant pain in my left clavicle.
I was taken to the Chi Mei Medical Center emergency room in Tainan, where an X-ray was performed.
The doctor observed that my clavicle was fractured, and the second and third ribs were broken as well.
However, the physician advised that surgery was not necessary and that I should use a figure-eight shoulder strap for stabilization.
Three days later, I returned for a follow-up appointment, during which the doctor provided some precautions and prescribed medication.
After two weeks, on September 7, I went back for another check-up, and another X-ray was taken to assess the healing progress.
The results confirmed a clear clavicle fracture with some displacement.
The doctor mentioned that the difference in angles during the imaging could account for the discrepancy in findings.
Doesn't this imply that they did not conduct a thorough examination initially?
Currently, my left clavicle has a noticeable bump, and I have a shoulder height discrepancy.
The doctor stated that since the periosteum is healing, I should allow it to heal gradually.
However, I am concerned that this may lead to improper bone alignment.
I feel very troubled and somewhat angry about the lack of attention to detail during my initial assessment.
Could you please clarify whether surgery is necessary? I am worried about potential long-term complications if surgery is not performed.

Thank you for your assistance.

wensun, 20~29 year old female. Ask Date: 2015/09/08

Dr. Shi Guozheng reply Orthopedics

Clavicle fractures are usually treated conservatively, typically with a triangular sling or figure-of-eight bandage for about three months, unless it is an open fracture or there is a risk of the fracture site penetrating the skin.
Additionally, if there are associated vascular or nerve injuries, immediate surgery may be necessary.
Since you have opted for conservative treatment, slight displacement or angulation of the fracture will not affect function once healed.
Recently, some have advocated for surgical intervention, which involves realigning the fracture and inserting a metal plate or screws.
This method also requires about three months for healing but may reduce discomfort and pain more quickly, allowing for an earlier return to work.
The downsides include the possibility of surgical failure or wound infection, and there may be a need for a second surgery to remove the hardware, with some costs potentially being out-of-pocket.
Regardless of the treatment approach, both methods can achieve the desired outcome, so it ultimately depends on your personal decision and discussion with your physician.

Reply Date: 2015/09/08

More Info

Clavicle fractures are common injuries, particularly in the context of trauma such as car accidents or falls. The clavicle, or collarbone, serves as a critical structural component of the shoulder girdle, connecting the arm to the body. Understanding the treatment options and recovery concerns associated with clavicle fractures is essential for patients navigating their healing process.

In your case, it appears that you sustained a fracture of the left clavicle along with rib fractures. The initial assessment by your physician indicated that surgical intervention was not necessary, and a conservative approach involving the use of a figure-eight shoulder harness was recommended. This is a common treatment for non-displaced or minimally displaced clavicle fractures, as it allows for stabilization and promotes healing while minimizing complications.

The follow-up X-ray you mentioned revealed a noticeable displacement of the fracture. It is not uncommon for fractures to appear differently based on the angle of imaging, and this can sometimes lead to confusion regarding the severity of the injury. However, the presence of bone growth, as noted by your physician, is a positive sign indicating that the healing process is underway. The concern about the bone healing in a misaligned position, leading to a "malunion," is valid. Malunion can result in functional impairment and cosmetic issues, such as shoulder asymmetry, which you are currently experiencing.

In terms of treatment options, if the fracture is significantly displaced or if there is a concern about malunion, surgical intervention may be warranted. Surgical options typically involve the use of plates and screws to realign and stabilize the fractured bone. This approach can facilitate proper healing and restore the normal anatomy of the clavicle, potentially reducing the risk of long-term complications.

Recovery from a clavicle fracture generally involves a period of immobilization followed by gradual rehabilitation. The timeline for healing can vary, but most clavicle fractures heal within 6 to 12 weeks. During this time, it is crucial to follow your physician's recommendations regarding activity restrictions and rehabilitation exercises. Physical therapy may be beneficial to restore range of motion and strength once the bone has sufficiently healed.

Regarding your concerns about potential long-term effects, it is understandable to feel anxious about the possibility of complications. If you continue to experience significant discomfort, functional limitations, or cosmetic concerns, it would be advisable to seek a second opinion from an orthopedic specialist. They can provide a thorough evaluation of your current condition and discuss the potential benefits and risks of surgical intervention versus continued conservative management.

In summary, while many clavicle fractures heal well with conservative treatment, factors such as displacement and alignment can influence the outcome. It is essential to maintain open communication with your healthcare provider and advocate for your concerns. If you feel that your current treatment plan is not addressing your needs, do not hesitate to seek further evaluation. Your recovery is paramount, and ensuring that you receive appropriate care is crucial for achieving the best possible outcome.

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