Clavicle injuries
It is very common to fracture your clavicle, typically after falling off a bike, or other type of accident. Patients feel pain over the collarbone, often with bruising.
Clavicle fractures are easily diagnosed on xray.
Over 95% of clavicle fractures will heal without surgery. A sling is used only for comfort, but over the first 6 weeks you should not use the arm to lift anything heavy, or above shoulder height.
Some surgeons believe clavicle fractures should be treated with surgery, especially if there is significant displacement. While this will speed recovery by a few weeks, the risk of infection and wound problems in this area is significant, as is the need to have the plate removed. The vast majority of clavicle fractures, even significant ones, will heal resulting in full shoulder function and no pain.
Very occasionally surgery is indicated, if you have multiple injuries, or are an elite athlete.
Patients can also sustain acromioclavicular joint (ACJ) dislocation or separation. Type 3 injuries are easily identified by the significant bump, and on xray.
Multiple studies have proven that early surgery does not improve patient outcomes, compared to treating patients with physiotherapy and rehabilitation. Up to 90% or more of patients will find that the discomfort and instability settles over 6 months, and never need surgery. If patients continue to have problems a year or more later, surgery can be performed to stabilize the clavicle.
Postoperative rehabilitation
Shoulder surgery is performed as day surgery at Women’s College Hospital. Someone must come and pick you up and take you home. It is advised to have someone around to help you for the first two days. All patients will be provided with a script for medications that should be filled at the hospital prior to going home. Medications will usually be Celebrex in the morning for 2 weeks, Aspirin at night for two weeks, and Tylenol regularly for the first week. A script for oxycodone will also be provided.
All patients will wear a sling to sleep and walk for 6 weeks after surgery. After one week, the sling can be removed when sitting in a chair, and patients are allowed to use a computer, keyboard, and mouse. Physiotherapy usually begins 6 weeks after surgery, once the shoulder is pain free, and the risk of retear is low.
If possible, patients should rent a Gameready machine, which provides ice and compression to the knee, significantly reducing postoperative pain. The information for the rental company will be provided to you. Patients are seen in clinic two weeks after surgery, for wound review.
Patients should take a week off work after the surgery. Patients are not allowed to play sport for 6 months after surgery.
Risks of surgery
Shoulder surgery is a relatively safe operation. This is open surgery, with a 1/100 risk of deep infection, major stiffness, DVT/PE, major nerve or blood vessel damage, and humerus fracture. Patients can get local areas of numbness around the incision, which typically improves over a year or two.
The risk of nonunion of a clavicle fracture after surgery is approximately 5%. Often the plate needs to be removed, as it is can be prominent.
The chance of a good outcome after AC joint stabilization is approximately 95%. If a hook plate is used, this needs to be removed 6 months after surgery.
Dr. Tim Dwyer 