What is the best treatment for a broken (fractured) and/or dislocated collarbone (clavicle)?
Whether you ride a bike, a horse, or take part in contact sports, you must read this!
Bicycles and broken and/or dislocated collarbones go together like a horse and carriage
(or so the song goes!)
We do not recommend going over your horse's handlebars!
If you are a cyclist, or horse rider, the odds are that you may fall some time, land on your collarbone and either break it, dislocate it, or both. I did both in an instant, falling off a bike, many years ago.
This article deals mostly with the fracture kind. However, there is often a dislocation suffered along with the fracture, usually involving avulsing the ligaments that secure the acromioclavicular joint (AC Joint). If the AC ligaments have been fully or partially ruptured, the collarbone will appear to be "floating" above the shoulder. Please refer to Christian's Story later in this article. Christian suffered a nasty fracture of his collarbone and rupture of the AC joint. If the ligaments of the AC joint are not repaired, then the "floating" will be permanent. While we may consider it of not much consequence, I differ. Floating collarbones, other than being unsightly, can cause a lifetime of complications that may only get worse as the years become decades:
Disturbed sleep when sleeping on the previously injured side.
Pain and dysfunction with many physical activities, such as throwing and serving in tennis.
Protective muscle spasms in the shoulder and neck because of irritation and inflammation of the AC joint. These can lead to neck problems, migraines and even numbness radiating down the arm because of nerve and blood vessel impingement.
Gradual arthritic degeneration of the joint.
Collarbone injuries are so common that the seriousness of their impact on the victim - short and long term - is often overlooked.
Collarbone injuries cause weeks, if not months of sleepless misery and may cause long-term disability, including chronic pain, if not treated properly from Day One.
These injuries are horrible because it is almost impossible to sleep well during the weeks it takes for the bones and ligaments to knit securely. Attempting to roll over in bed is an agonising effort and unhelpful for the cause of uninterrupted healing. I'm talking from experience here, folks!
Think of the shoulder and collarbone acting like a car bumper during a crash. As you land on your shoulder, the collarbone crumples, absorbing some impact that might otherwise transfer to the central core of the body, shattering ribs, bruising and tearing vital organs; injuries that may be life threatening, if it was not for the crumpling of the shoulder. Not that this thought is any great comfort after suffering a shattered shoulder!
Clavicle fracture treatment
Clavicle Ligament Injuries
What is the best treatment for you? Get the best advice and make it timely!
From viewing these videos one can conclude that these injuries can be complex and there are risks involved in both conservative and surgical treatment options, including nerve damage. The extent of a collarbone injury may not initially be apparent; hence the need for a close examination by an experienced senior doctor and not just a trainee Accident and Emergency Department doctor. The decision as to the best treatment for you must be with the input of an experienced shoulder surgeon - in consultation with you - taking account all factors, including your lifestyle aspirations.
"Breaking my collar bone was nothing new to me as I had done it twice in the past. The first time the bones though broken were aligned and left to heal on their own. The second they were so far apart that surgery was the only option. I had some complications with the surgery in that the plate separated and another had to be fitted. Given this complication it still healed faster than the first time.
12 months ago I broke a collar bone again, third time! The xray was clear, the bones were miles apart.
The registrar suggested we leave it for a few weeks and see if the bones would realign. Given my job requires the use of my arms and I was keen to get back onto the bike this was not what I wanted to hear.
I contacted Gary Moller, he offered me great advice and introduced me to Marco who had been in a similar situation. I argued my case with the registrar pointing out that if left to heal on its own with a bump as often it does I would be back getting it fixed properly so lets plate it now and avoid extra costs in the future. He agreed and two weeks after the break I had a plate fitted."
It's almost impossible to immobilise a shattered shoulder
Because of the complex structure and mechanics of the shoulder (It's a four joint structure: scapulothoracic joint, glenohumeral joint, acromioclavicular joint and the sternoclavicular joint), it is almost impossible to stabilise the fracture or dislocation with any kind of strapping or sling, no matter how fancy. Unless we immobilise the damaged bones and ligaments, recovery will be slow and they will not knit well. This is especially true for the AC joint ligaments. Unless we hold the joint in place for several weeks, the ligaments will either not knit back together, or they may remain permanently apart, or lax.
If you want to restore the AC joint to as close to it original state, the best option may be surgical repair and plating, and it is best done promptly and not a month or longer after the injury.
Painkillers, sleeping and anti-inflammatory medications
Pain is there to remind you not to move, so that the bones and ligaments can knit securely. If painkillers allow excessive movement, such as when sleeping, then you risk ending up with a non-union healing of the fracture and/or an unsightly deformity of the collarbone and a biomechanically weak shoulder. We must hold together the bones and joints. Pain helps you do that. There is advice about pain management later in this article.
I have seen a few cases of non-union bone and many floating AC joint over the years. The only solution for those with the bone non-union is surgery, often years after the original injury. For those with an old floating AC joint that is giving them trouble, I'm afraid the only option, as far as I know, is palliative treatment using anti-inflammatory medications, or the occasional surgical intervention.
Anti-inflammatory medications may interfere with the healing processes. While their use may cause a marginally quicker recovery, this may be a false recovery, since the structure may be less than 100% integrity. Please refer to my blog article about anti-inflammatory medications:
Is surgery for a fractured and/or dislocated collarbone the best treatment?
"I broke my collarbone at the shoulder joint this week and have been to ED last night where they told me they would just let it knit while I wear an arm sling."
In 30+ years of working in sports medicine and rehabilitation, and seeing many fractured collarbones, I have never seen a complication from the surgical plating of these fractures. I have seen many cases of slow and painful healing, non-union of fractures, unsightly deformed collarbones, lop-sided shoulders and permanent biomechanical weaknesses; all because of the patient being given a sling, a pile of drugs and being told to go home.
These injuries can signal the end of your time as a high performance athlete, if you are one. The gloss may be permanently off your peak performance if not treated properly.
The time it takes for return to work and for resumption of near normal activities is usually less than half the time of merely leaving most of these injuries in a sling.
Even if the fracture is extreme, you may still be told that surgical plating of a broken or dislocated collarbone is not an option. This is a polite fib - but it is the norm statement nowadays. Why?
Perhaps some emergency medical room doctors do not know the difference between the treatment for a fractured collarbone versus a dislocated one.
The extent of the injury may not be obvious on first assessment.
Surgery to the collarbone area can be complex and is not without risk.
There is a view that a complete rupture of the AC joint results in little lasting disability; whereas a partial rupture may be more disabling over the long term. By extension of this, surgical repair of an AC rupture may cause the bone ends of the AC joint, which were well apart, to be too close, such that they may grind against each other, because of the ligaments being too lax. My answer to this line of reasoning is this: "Do a good repair job in the first place and make it timely!"
Perhaps the medics have seen so many of these injuries that there is no longer a sense of concern or urgency.
Limited funding and busy operating schedules may delay surgery for weeks, by which time healing is well on its way (more about this later).
Frustration turning to anger as the days become weeks
"Hi Gary, Not too good. Very condescending ortho, now thinking of another tack if possible. What really irks is that no Dr has even looked at my X-ray.
Thoroughly pissed off. Treated me like some old lady, well I am, but a bolshy one who still likes to ride descents fast."
The Hospital Emergency Department doctor may tell you to go home, take lots of painkillers, and wear a sling for several weeks. This is usually far from good enough.
The optimum window for doing the surgery is 10-14 days post-injury while the shattered and ragged ends are still fresh.
Not offering surgery may be partly because of it taking too long for funding to come through for the operation. ACC and other insurers have a history of being reluctant to pay for surgery on injuries that may not keep a person away from work for more than a few weeks.
Important to know!
The orthopaedic department at your hospital may meet only once every two weeks to review cases that may require treatment outside of standard procedures and budget.
Ask when the next review meeting is and insist on being included, otherwise delays will drag out into weeks and you will lose the opportunity for a nice and quick repair job.
If you are in a job, such as a mechanic, which depends on you having strong and functional shoulders and if the injury is preventing you from returning to work quickly and it looks like dragging on for weeks and maybe months. Hopefully, you will be into surgery within a week (More about this later). Money talks with agencies like ACC, which explains why a worker unable to work due to an injury will have faster and better treatment than, say, the proverbial "Little Old Lady".
Another very frustrated patient
I'm still waiting...aaargh!
I met with the surgeon last Wednesday...he thought surgery would be required but at the last minute asked me to wear the sling for one more week!"