Often a fractured clavicle (collarbone) can be treated without surgery. However, sometimes the fractured pieces of bone are out of place (displaced) or other factors about the patient or injury make surgery the treatment option. The surgery is done with the use of orthopedic implants and instruments provided by orthopedic implants manufacturers in India.
Conventional wisdom and mixed opinions regarding clavicle surgery
In the past, conventional wisdom was that a broken clavicle would nearly always heal properly without surgical intervention. Some experts now question this notion, and there is no consensus on the treatment of most displaced fractures of clavicle shaft. For example:
- A 2017 study reviewing more than 600 patients noted that surgery can decrease the risk of non-union (when the broken parts of the clavicle fail to heal back together) but concluded that surgical and nonsurgical patients had similar range of movement and shoulder strength after healing.
- Another study that looked at more than 400 patients concluded that surgery shortens healing time and thus would allow athletes to return to play sooner. The same study also observed better, more complete healing in surgical patients, but only a small improvement in range of movement and long-term shoulder when compared to nonsurgical patients.
Until more definitive research is available, this topic will remain controversial. For now, orthopedic surgery to repair a broken clavicle is usually optional and not required, so the doctor and patient must consider the potential benefits and risks of surgery. If surgery is required,
the doctor will also have to decide what orthopedic implant and tools are to be used during surgery.
Types of Surgery for Clavicle Fracture
Surgery for a fractured clavicle typically involves an open incision to move the bone fragments into proper place and then secure them in place. There are two common surgical options:
- Plate fixation, which entails attaching a plate with bone screws to the outside of the bone
- Intramedullary fixation, which involves inserting a long pin into the center of the bone
Both intramedullary fixation and orthopedic plate fixation have advantages and disadvantages.
Intramedullary fixation typically uses a smaller incision and causes lesser disturbances to the surrounding soft tissues. However, intramedullary fixation sometimes requires a second surgery to remove the hardware.
Plate fixation hardware is often left in place but occasionally causes irritation from backpack straps or seatbelts, because the clavicle is prominent and close to the surface of skin. Research shows that around 10% to 15% of plate fixation patients decide to have their hardware removed, and that women are more likely than men to undergo removal.
Hardware removal is done as an outpatient surgical procedure, often with general anesthetic. Hardware removal results in small voids in the bone (typically holes previously occupied by bone screws) and the surgeon may recommend the patient take postoperative precautions to prevent injury. However, the recovery overall is usually much faster than recovery from the original fixation surgery because the fracture should already be healed, and the associated soft tissue injury is less than during initial fracture.
Patients should consult their surgeons to know the approach that is right for them.
Managing Post-Surgical Pain
An anesthesiologist may manage a peripheral nerve block that numbs the area around the clavicle, where the surgeon will operate. A peripheral nerve block can be used along with general anesthesia. Following surgery, the peripheral nerve block may work for a brief time after the general anesthesia has worn off. This allows a patient to emerge from general anesthesia and regain consciousness without any pain.
Whether a peripheral nerve block is used or not, the patient will ultimately experience pain that must be managed.
Pain can be managed with these tactics:
- Taking prescribed opioid (narcotic) pain medication during the short term. It is important to take opioids only as directed.
- Taking non-steroid anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen once the patient is no longer taking an opioid.
- Using cold therapy for 10 to 15 minutes many times a day. This decreases inflammation and dulls pain signals to the brain.
Propping pillows around the affected arm to help with sleep, or perhaps sleeping upright in a comfortable chair for the first few nights after orthopedic surgery.