Operative Treatment for Clavicle Fractures (Broken Collarbone)

Operative Treatment for Clavicle Fractures (Broken Collarbone)

Clavicle fractures are often caused by a direct blow to the shoulder. In sports, it usually occurs when an athlete is tackled in a football game, falls of a bicycle, or gets body-checked into the plexi-glass of an ice rink. It can also happen during a fall onto the shoulder or a car collision, a fall onto an outstretched arm, or in childbirth, when the baby is passing through the birth canal.

The clavicle is a long bone and most breaks occur in the middle of it. Occasionally, the bone will break where it attaches at the ribcage or shoulder blade.

Clavicle_OSS

Symptoms

Clavicle fractures can be very painful and may make it hard to move your arm.

Additional symptoms include:

  • Sagging shoulder (down and forward)
  • Inability to lift the arm because of pain
  • A grinding sensation if an attempt is made to raise the arm
  • A deformity or “bump” over the break
  • Bruising, swelling, and/or tenderness over the collarbone

Evaluation by an OSS physician

In order to pinpoint the location and severity of the break, your OSS physician will order an x-ray. X-rays of the entire shoulder will often be done to check for additional injuries. If other bones are broken, your doctor may order a computed tomography (CT or CAT) scan to see the fractures in better detail.

If your bones are out of place (displaced), your OSS physician may recommend surgery. Surgery can align the bones exactly and hold them in good position while they heal. This can improve shoulder strength when you have recovered, if displacement is significant. A recent large study showed improvement in function with operative repair when the fracture is significantly displaced.

The use of Plates and Screws

During this operation, the bone fragments are first repositioned into their normal alignment, and then held in place with special screws and/or by attaching metal plates to the outer surface of the bone. Newer locking plates are contoured to give significant strength while minimizing the prominence of the plate. Many patients notice immediate improvement in the disturbing bone movement right after surgery.

After surgery, you may notice a small patch of numb skin below the incision. This numbness will become less noticeable with time. Because there is not a lot of fat over the collarbone, you may be able to feel the plate through your skin. It is important to start full range of motion soon after surgery.

Plates and screws are sometimes removed after the bone has healed, but that is up to the patient’s discretion. This is a much smaller procedure with little down time, usually 4-6 months after the original surgery.

img2

(A) The clavicle is broken in more than one place and the fragments are severely out of alignment. (B)The fractured pieces are held in place by a combination of plates and screws.


Rehabilitation

Specific exercises will help restore movement and strengthen your shoulder. Your OSS physician may provide you with a home therapy plan or suggest that you work with a physical therapist.

Therapy programs typically start with gentle motion exercises. Your OSS physician will gradually add strengthening exercises to your program as your fracture heals.

Although it is a slow process, following your physical therapy plan is an important factor in returning to all the activities you enjoy.

Surgical Complications

People who use nicotine, have diabetes, or are elderly are at a higher risk for complications during and after surgery. They are also more likely to have problems with wound and bone healing. Be sure to talk with your OSS physician about the risks and benefits of surgery for your clavicle fracture.

There are risks associated with any surgery, including:

  • Infection
  • Bleeding
  • Pain
  • Blood clots in your leg
  • Damage to blood vessels or nerves
  • Nausea

The risks specific to surgery for collarbone fractures include:

  • Difficulty with bone healing
  • Injury to surrounding vessels/organs (rare)
  • Hardware irritation

Outcome

Whether your treatment involves surgery or non-surgical treatment, it can take several months for your collarbone to heal. It may take longer in diabetics or people who nicotine.

Most people return to regular activities within 3 months of their injury. Your OSS physician will tell you when your injury is stable enough to do so. Returning to regular activities or lifting with your arm before your doctor advises may cause your fracture fragments to move or your hardware to break. This may require you to start your treatment from the beginning.

Once your fracture has completely healed, you can safely return to sports and daily activities.

What to discuss with your OSS Surgeon

  1. When will I be able to start using my arm?
  2. When can I return to work?
  3. Do I have any specific risks for not doing well?
  4. If I have surgery, what are the risks and benefits and how long will I be in the hospital?
  5. If I do not have surgery what are the risks and benefits?
  6. Is my bone weak?
  7. Should I be taking calcium and Vitamin D?

If you would like more information about clavicle surgery, call Orthopedic Specialists of Seattle (206) 633-8100 to schedule an appointment with Dr. Ruhlman.

Dr. Ruhlman Featured in Swedish Ballard

This is Swedish Ballard’s third post in a four-part series to encourage and inspire Ballard residents and the surrounding communities to be healthy while leading active lifestyles in 2014.  Below, posted in its entirety, is the article from Swedish Ballard’s web site; posted 1/29/14.

By Scott Ruhlman, MD
Orthopedic Surgeon

Looking to be more active in 2014? Have you been waiting all year to enjoy winter sports such as skiing or snowboarding?

There are a few common injuries that often get my patients down when they are on the go. Below are a few tips and tricks to help you prevent these common injuries and determine the best treatment options should you need it.

Sprains/Fractures
The most common injuries in the wrist and ankle are sprains and fractures. Throwing, twisting, weight-bearing, and impact can put you at risk for a wrist injury. Ankle sprains and fractures are typically caused by making a fast, shifting movement with your foot planted on the ground.

In most cases, I recommend the RICE approach: rest for around 48 hours; ice the injured area to reduce swelling (use a pack wrapped in a towel); compress with an elastic ACE wrap; and elevate the injury above heart level.

However, if you experience these symptoms, contact your provider for further evaluation.

  • Pain at the time of injury
  • Swelling
  • Bruising or discoloration
  • Difficulty moving the wrist or ankle
  • A “popping” or tearing sensation during the trauma
  • Warmth and tenderness of the skin

More serious injuries will likely be treated with a splint, boot or cast. The healing process can take up to six weeks. Surgery may also be required.

ACL Tears
The ACL, or anterior cruciate ligament, is one of the major ligaments in your knee that helps with stabilization when turning or planting. ACL injuries take place during cutting or pivoting movements. The hallmark of a torn ACL is a distinct popping noise and your knee may give out. The affected knee will begin to swell and become stiff between 2-12 hours after the injury. People often experience pain or tenderness, and discomfort while standing or walking.

Treatment for ACL injuries depend on the severity of the tear, as well as your age and activity level. Non-surgical treatment such as physical therapy or using a brace may be sufficient. Other individuals will need reconstructive surgery. In all cases, it is important to consult with your provider as soon as possible if you suspect a problem.

Rotator Cuff Tears
The rotator cuff is a group of four small muscles and tendons in the shoulder that provide stability to the shoulder and mobility to the arm. A torn rotator cuff can happen in two ways. An acute tear happens suddenly, such as when you fall on an outstretched hand or lift a heavy object. Tears can also happen slowly over time. As we age, the tendons of the rotator cuff become weaker and gradually fray.

Symptoms of a rotator cuff tear include pain with movement of the shoulder and tenderness to touch. Inability to lift even household objects out to the side or overhead is also typical. Another indicator is a prior history of shoulder tendonitis or bursitis as this would point to excessive stress on the rotator cuff over time.

Treatment can be conservative for some tears, including physical therapy to improve shoulder mobility and progressively strengthen the cuff muscles. However, the majority of tears will likely require surgery to restore shoulder function.

Meniscus Tears
The meniscus helps to absorb shock, as well as stabilize the knee joint. A lot of your body weight is distributed through the meniscus when you move, especially when performing athletic activity. Meniscus tears are caused by twisting and compression that can occur with such activities as running or jumping.

If you have a meniscus tear, you may hear a popping sound or feel a tear or rip in the knee. Swelling generally occurs within a few minutes to a couple of hours and your knee might feel like it is out of place. In less acute injuries, swelling may not occur. Your knee might feel like it’s catching during movement, or like it’s “out of place”. If you suspect you may have a meniscus tear, make an appointment with your provider right away.

Initial treatment of a meniscal tear is typically nonsurgical, and may include RICE (rest, ice, compression and elevation). If the tear doesn’t heal, you may need surgery.

Prevention
While the majority of these sports injuries are due to circumstance and pre-existing injuries, there are precautions that you can take to help prevent them from happening to you:

  • Maintaining a lifestyle involving consistent exercise
  • Warming up and stretching prior to rigorous activities
  • Cooling down and slowly relaxing after exercise.

Dr. Scott Ruhlman practices orthopedic surgery at Orthopedic Specialists of Seattle, and has extensive experience with sports medicine. If you have any questions regarding your shoulder pain or function, please feel free to contact Dr. Ruhlman’s office at (206) 784-8833.