Complications After Clavicle Fractures: Healing and Rehabilitation

Post-fracture complications of the clavicle?

Hello Doctor: I would like to ask about my situation.
I have had two fractures of my left clavicle.
The first one was a distal fracture, for which I underwent surgery using screws and artificial ligaments for fixation, and the screws do not need to be removed.
The second was a midshaft fracture, where a plate and screws were used for fixation.
However, three months post-surgery, the plate and screws penetrated the skin, leading to a debridement surgery.
Two months later, the screws again penetrated the skin, so the plate and screws were removed early on August 31, after being in place for five months.
Currently, X-rays show that the bone has healed, but the midshaft of the clavicle appears slightly thinner than the other side.
Is this considered normal? Will the bone continue to grow? My clavicle is not painful now, and my arm is still in a sling.
Under what conditions should I start rehabilitation? Additionally, since the surgery on August 31, the healing of the surgical wound has not been ideal; the skin around the midshaft of the clavicle is purplish and fragile, and it has not healed well.
It seems that the artificial ligament from the first distal fracture surgery is also protruding about a centimeter from that area.
How should I manage this wound? Could using artificial skin help with healing, or are there other treatment options? The debridement surgery did not reveal any bacterial infection, but I am still worried about the possibility of osteomyelitis affecting wound healing.
Currently, there is no pain in the clavicle; could this still be osteomyelitis? Thank you for your patient response.

Angel, 20~29 year old female. Ask Date: 2015/09/28

Dr. Shi Guozheng reply Orthopedics

Once the bone has healed, you can start to engage in activities, but it is important not to exert too much force.
Wound care can involve the use of artificial skin, and it is advisable to frequently change the dressings to keep the wound dry and clean, which will promote gradual healing.
If the wound is free of bacteria, the likelihood of developing osteomyelitis is reduced.
However, if there is persistent pus coming from the wound, it may indicate the presence of osteomyelitis.

Reply Date: 2015/09/28

More Info

Understanding complications after clavicle fractures, especially in the context of multiple surgeries and healing challenges, is crucial for effective rehabilitation and recovery. Your situation, involving two separate clavicle fractures with surgical interventions, presents unique considerations regarding healing, rehabilitation, and potential complications.

Firstly, it’s important to note that the clavicle, or collarbone, is a critical bone that connects the arm to the body. Fractures in this area can lead to various complications, especially if surgical fixation is required. In your case, the use of screws, plates, and artificial ligaments indicates a significant injury that necessitated careful management.

Regarding your concern about the healing of the clavicle, it is not uncommon for the bone to appear thinner or less robust on X-rays after a fracture, particularly if there has been a history of multiple fractures and surgical interventions. Bone remodeling is a natural process that occurs after a fracture, where the body gradually replaces old bone with new bone. While your clavicle may appear thinner, it can still strengthen over time, especially with appropriate rehabilitation. However, the extent of this remodeling can vary based on factors such as age, nutrition, and overall health.

As for when to start rehabilitation, it is generally advisable to begin gentle range-of-motion exercises as soon as the surgical site has sufficiently healed and the surgeon has cleared you for activity. Since you mentioned that your clavicle is currently not painful and you are still using a sling, it’s essential to follow your surgeon's guidance. Typically, rehabilitation may begin with passive movements, gradually progressing to active movements as tolerated. The goal is to restore function without compromising the healing process.

Regarding the skin issues you are experiencing, such as the purple discoloration and the exposure of the artificial ligament, these are concerning signs that should be addressed promptly. The skin's integrity is crucial for healing, and any signs of compromised skin can lead to further complications. Using artificial skin or advanced wound care products may help promote healing, but it’s essential to consult with a wound care specialist or your orthopedic surgeon for tailored advice. They may recommend specific dressings, topical treatments, or even further surgical intervention if necessary.

Your concern about the possibility of osteomyelitis (bone infection) is valid, especially given the history of skin issues and surgeries. While the absence of bacteria in cultures is reassuring, it does not entirely rule out the possibility of infection. If you experience any new symptoms, such as increased pain, swelling, redness, or fever, it is crucial to seek medical attention immediately.

In summary, while your clavicle appears to be healing, the thinner appearance on X-ray and the skin issues require careful monitoring. Engaging in rehabilitation under the guidance of a healthcare professional is essential for restoring function. Additionally, addressing the skin concerns with appropriate wound care strategies is vital to prevent complications. Regular follow-ups with your orthopedic surgeon will be crucial in ensuring a successful recovery and addressing any emerging issues promptly.

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