The clavicle is a bone that connects the upper extremity to the torso. It is not a bone with a huge tolerance for deformity, it usually breaks rather than bends under significant stress. The most common way to sustain a fracture of the clavicle is either a direct blow or from falling on an outstretched arm. While it is uncommon for a clavicle fracture to lead to injury to a nerve or blood vessel, there are some close by so with the fracture separates there can be injury to the structures. When a patient sustains a broken clavicle, there is often bruising around the injury and evidence of some bony deformity in the region. Skin abrasions may be present and the shoulder itself is very painful to move. Depending on the energy involved with the trauma, there may be associated injuries to the shoulder girdle or potentially nerves or blood vessels. If there is substantial associated injury, surgery right away may be necessary with a Phoenix orthopedic surgeon. Radiographs will typically show a clavicle fracture very nicely. It would be unnecessary for a patient to need an MRI to make this diagnosis. A CAT scan may help with a skeletally immature patient with an open growth plate or in a situation where there is a fracture dislocation. The majority of clavicle fractures are able to avoid surgery and be treated conservatively. Most fractures occur in the middle 3rd of the bone and healing occurs uneventfully without surgery. About 5% of these fractures do not heal and develop what is called a nonunion. There are also times when a fracture will heal but at an unsatisfactory angle. This is called a malunion. The best indicator of whether or not a patient is going to have future problems is if a broken bone is displaced and bony contact is not present. In addition, research has shown that if the fracture shortens over 2 cm outcomes tend to be worse. Those patients end up with less strength than otherwise. If surgery is necessary for a fracture of the middle 3rd of the clavicle, there are plating techniques available that allow for adequate healing. They do involve a scar obviously and there is also a procedure that involves fixation through the bone which is called intramedullary fixation. This can be accomplished with a screw or a threaded pin. Fractures of the distal 3rd of the clavicle, which is the end of the bone, involve 15% of these fractures. These fractures have various categories depending on how close to the end of the bone they occur and tend to be more complicated than those of the middle third. If the broken bones are displaced from one another, surgery is often a good idea. There is a high propensity for nonunion and residual disability when the bones are displaced and surgery is not performed. Fractures of the medial 3rd of the clavicle, which is the inside part of the bone, are rare. Two to 3% of clavicle fractures are in this region and when they do occur a patient’s airway and large vessel needs to be assessed promptly. Patients who have clavicle fractures should not simply assume surgery is unnecessary. They should seek treatment from an accomplished orthopedic surgeon such as Sumit Dewanjee MD at FXRX. Dr. Dewanjee is a Board Certified, Fellowship Trained orthopedic surgeons phoenix az seeing patients in the greater Phoenix Metropolitan area. Call 480 349-FXRX to make your appointment Today!
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