Ask Dr. Geier – Clavicle Fractures

Merry Christmas to everyone in Charleston and across the country! I want to start by apologizing for the lack of frequent posts over the last month or so. December is always a busy time of the year for me professionally. All of the high school and college athletes want their surgeries during their winter breaks, and adults who have met their deductibles want any necessary surgeries before the end of the year to avoid out-of-pocket expenses. That’s great, but it has led to really long days and weeks with little time for writing.

Also, I am restarting the Ask Dr. Geier column, but I’m moving it to Mondays. I just couldn’t motivate myself to write on Fridays, and I write the more topical posts (like the Post and Courier and the STOP Sports Injuries posts) earlier in the week. I appreciate everyone’s questions, and I have many to answer in the coming weeks. Please keep them coming!

I will say, though, that I am reluctant to use these posts to address people’s specific concerns, especially when they are questioning their doctors. I can give general information about the topic, but since the questioner is not a patient, I am not able to offer medical advice specific to that person. Please note the disclaimer on giving medical advice online or via email. I don’t mean to be discouraging, but I can only offer general information in this format. I would be happy any time to help more formally, but I can only do that in my office. With that said, Happy Holidays!

David

Aaron in Corpus Christi, TX writes:

Hi Doc,

I have a question about broken clavicle remediation. I’m 35 and broke my clavicle last week. I’ve read conflicting reports on whether or not to wear a sling, a figure-of-8 strap or just go for the surgery.

I’ve read in cases where there is just a fracture and no displacement, a sling or 8 should suffice, but what are your thoughts on executing surgery and installing a plate in cases where displacement has occurred (2-3 cm) and the individual would like to return to an active lifestyle of mountain biking and contact sports? I know you can’t diagnose over the internet, but any thoughts you have on sling, figure 8 or surgery will help in my decision on Monday.

Thanks so much for your thoughts and your website has been a big help!

The management of clavicle fractures has certainly been evolving over the last few years. I wrote about surgical treatment of clavicle fractures in my post a few months ago about Tony Romo’s injury.

In general, I think that nonoperative management of clavicle fractures is acceptable for a large percentage of these injuries. If the ends of the bone line up fairly well with minimal displacement, the use of a sling or figure-of-eight strap is definitely appropriate. I am fairly aggressive getting people out of the sling once the fracture starts to heal in order to start working on range of motion and strengthening. Use of the sling or strap is more for the patient’s comfort than to get it to heal properly. While the fracture is still new, patients can often feel the fracture edges moving against each other, so for the first few weeks I think a sling is fine.

Surgical treatment, either using a pin down the center of the bone or a plate and screw construct, has become more accepted for displaced fractures. In situations where the ends of the bones are not touching, especially when there is significant separation, I think surgery is appropriate. The study in The American Journal of Sports Medicine that I referenced in the Tony Romo column notes how surgical management might be more appropriate for athletes of contact and collision sports. In these displaced fractures, I think that all active people, not just athletes, are less likely to have issues with weakness or lingering soreness with surgery than with nonoperative management. Surgery lines up the ends of the bone better, creating less of a lump at the fracture site. Surgical treatment does make the surgeon more comfortable knowing that the fracture is more likely to heal. The first few visits obtaining x-rays to follow nonoperative management of displaced fractures is always somewhat nerve-racking, as it is hard to know if that fracture will go on to heal. Certainly primary fixation of a fracture is easier and more reliable than treatment of a nonunion. Also, surgery allows the patient to start physical therapy for motion and strengthening much earlier, as the fracture doesn’t need to be protected in a sling or other immobilization for a long at all.

It will be interesting to see if the tide for management of clavicle fractures swings in the opposite direction (surgical treatment) in the coming years as long-term data regarding pin or plate and screw fixation of these fractures becomes more available.

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