A broken collarbone is most often caused by a blow to the shoulder or falls, particularly when falling onto the side of the body. These are usually sports-related injuries, occurring most frequently in cycling or sports that require jumping, extreme action, etc.
A collarbone can be broken in a variety of ways. In some cases, the bone may be completely broken, which often includes the shifting or displacement of bone fragments. Sometimes though, some parts of the broken collar bone may still be connected, while in other cases the bone may be broken into a number of small pieces. The latter will cause symptoms of swelling and pain, and the patient will not be able to lift the affected arm or will find it difficult to move the arm due to the intense pain. The collarbone acts as something like a suspension bridge connecting the scapula, shoulders, arms and the central bones of the torso and arms together, while the muscles surrounding the shoulders must have a length appropriate to the body and physique of each individual person, so that they have the strength needed to function and provide movement. When the collarbone is broken, it can cause shrinking or shortening of the bone or muscle, thereby decreased strength, drooping or downward-curving of the shoulders, and a lack of ability to move or lift the arms.
Treatment of a broken collarbone depends on the characteristics, symptoms and indications of each individual patient, and may be surgical or non-surgical.
Non-surgical treatment is generally used in cases of hairline or partial fractures, non-displaced fractures and when there is a high chance that the bone will heal on its own and in its original position. In these cases, using a simple arm sling for about two weeks is generally sufficient, along with pain medication. Once the pain begins to decrease, the patient may start with some gentle exercises that should not be too strenuous. After about three months, once the bone has more fully healed, more strenuous exercises can begin. There are, however, limitations to this kind of treatment. The main issue is that about 5% of these cases result in nonunion of the bone (bone pieces fail to heal together properly), or the bones may heal together in the wrong position (malunion), causing a large bump to develop over the fracture site as it heals and thus affecting the appearance. In some cases, the bones may heal together, but the clavicle is shortened by more than 2 centimeters, which causes a risk of unsatisfactory functional outcomes and shoulder weakness. Cases like this are very difficult to correct and the shoulder may not be able to return to normal.
Indications for surgical repair of a broken collarbone include absolute fracture of the bone, more than 100% displacement or more than 2 centimeters shortening. Surgical treatment can help to reduce chances of nonunion or malunion healing.
The current surgical procedure used is known as minimally invasive plate osteosynthesis (MIPO), which involves the insertion of special metal hardware under the skin through small incisions known as portals. After insertion, the metal is then tunnelled along the surface of the bone to enable internal fixation of the fracture. This type of surgery results in far less tissue trauma and nerve damage than traditional open surgery, along with improved treatment outcomes and only one night of inpatient recuperation. As a result, it is far more cost-saving in terms of hospital stay and post-surgery care.
This type of surgery is key in cases where the bone has broken into many pieces or fragments (comminuted fracture), as this particular technique does not interfere with the fracture fragments themselves, thus offering much better treatment results. Many people probably wonder how such fractures could possibly heal back together without anatomically reconstructing individual fracture fragments, but our bodies are amazing organisms. Normally, when we have a broken bone, blood will flow to the area surrounding the bone, so that the fragments will not scatter. Unlike a broken glass, which will shatter and spread pieces far and wide across the floor, the blood that surrounds a broken bone creates a substance that can help heal and connect the fragments. Therefore, being able to avoid interference with the fracture site itself means that no more additional trauma is caused to the area, leading to better surgical outcomes.
Once the plate has been inserted, after about two weeks of immobilization, the patient can begin to move and start with rehabilitation. After about three months, the doctor will allow the patient to resume more strenuous functions and exercise, as the bone will have begun to heal together more completely. At about six months, the plate can be removed and the patient can return to his or her normal lifestyle and activities.
“Many people may be apprehensive or afraid of surgery, or even try to avoid surgery altogether. If there are indications for surgery, however, treatment should be carried out promptly, as surgery can help avoid problems related to nonunion or malunion. If you have a broken collarbone and find out that surgery is needed, you should come to a decision within two weeks, as it is during this time that the bone will begin to heal back together. If the fracture is left for too long without proper treatment, malunion and deformity can occur. In this case, even if you do eventually have corrective surgery, the procedure will be more difficult. If the bone has already shortened, it may not be able to correct the bone with as good an outcome as would have originally been possible. Therefore, the faster the decision-making and the faster the surgery are carried out, the greater the benefits. Very importantly as well, surgery today involves much smaller incisions, less pain and faster recovery, so there really is no need to be afraid of this surgery.”
Faculty of Medicine Ramathibodi Hospital, Mahidol University , 2008