Clavicle (collar bone) fracture repair - ORIF
Pre-Operation
Although many collar-bone (clavicle) fractures will heal without surgery, even those with considerable displacement, there are a sub-group of these fractures which are better managed with surgery. There are also other social factors that may have an influence on treatment, especially in the performance athlete.
Operation
The procedure is performed in an operating theatre with the patient under a general anaesthetic.
An incision is made along the length of the collar bone, the fracture exposed, the fragments pieced together and secure with a combination of metal screws and a metal plate, in most cases.
The wound is closed with dissolvable sutures and the patient placed in a sling. Most patients will go home on the day of the surgery.
The surgical team do their best to make sure that complications do not happen. However there is a risk of these with any surgery. Although rare, the more common ones are listed below. The patient is invited to ask the surgeon and / or anaesthetist about any potential complications about which there are concerned.
Potential
complications
Despite our best attempts, potential complications are a risk with any injury or surgical procedure. You need to be aware of these rare potential complications.
The more common ones are listed here, but please ask the surgeon if there are any you are particularly concerned about.
1. Wound healing problems or infection
Sometimes the wound can heal with a prominent scar or keloid. Wound infection may also occur and require treatment with antibiotics
2. Deep infection
This is a rare complication, less than 1% of case, and may required both intravenous antibiotics and / or a return to the operating theatre to wash the wound out
3. Fracture - delayed healing or non-healing (non-union)
This is another rare complication and avoided with careful surgical technique. However sometimes it can happen despite this. If it occurs it may required a revision of the procedure and possible use of bone graft.
4. Pneumothorax
This is a very rare complication which can occur if the lining of the lung, which lies very close to the collar bone, is damaged during the surgery and allows air to enter the space around the lung on one side, which collapses. The other lung will remain inflated and the anaesthetist will be able to ensure that the patient is breathing sufficiently. However it is a potential serious complication and the surgeon does his best to ensure it does not happen.
5. Cutaneous nerve injury / numbness
There are a number of skin nerves that run over the collar bone and the incision will damage some of these. The surgeon will try to keep this to a minimum but there may be an area of numbness near the scar.
6. Nerve or vessel injury
There are a number of larger nerves and vessels which lie deep to the collar bone, and can be damaged in very rare circumstances. This can cause serious nerve defecits and / or serious bleeding, but is very rare and the surgeon does his utmost to ensure this never happens.
Post-Operation
Click on this link to view a PDF of the post-operative instructions following ORIF of a clavicle fracture
https://www.cosm.net.au/wp-content/uploads/2018/04/Clavicle-fracture-ORIF.pdf
Rehab / Physio
Patients are allowed to begin movement and use of the operated arm when the pain has settled and the wound has started to heal, for activities such as using a computer, eating and bathing / washing.
Nothing heavier than a drink is to be lifted until there is clinical and x-ray evidence of healing of the fracture. This is checked with an x-ray at 6 weeks post surgery.
It is important that the physiotherapist ensures that the shoulder and surrounding joints (scapula or “shoulder blade”, in particular) are used correctly during the rehabilitation
Use of a stationary bike is possible as soon as the pain settles, while running is usually not possible until around 4-6 weeks and as long as the patient is careful and does not fall.