Written by Sara Gould, MD, MPH, RMSK
Clavicle Fractures
Whether Tony Romo’s recent clavicle fracture in the Dallas Cowboy’s game against the Philadelphia Eagles impacts you personally because you’ve suffered a similar injury, or because you need him for your fantasy football team, you may be interested in knowing more about how clavicle fractures are managed. (For the gruesome footage of the actual injury, click here )
Background
Clavicle fractures are fairly common injuries, making up approximately 4% of all fractures. The clavicle is also sometimes called the collarbone. The injury usually results from a direct blow to the shoulder or a fall on an outstretched arm. People who sustain this fracture tend to be younger and more active than the general population. While additional injuries are rare, they can be serious. Such injuries include: shoulder blade (scapular) fractures, rib fractures, punctured lung (pneumothorax), injury to the nerves (brachial plexus) and arteries that run near the bone (subclavian).
How do I know if I have a clavicle fracture?
The symptoms of a clavicle fracture can range from pain in the shoulder to bone poking through the skin in severely displaced fractures. Most people have difficulty moving their arm due to pain. The diagnosis could be based on these symptoms, but an x-ray is usually necessary to confirm. Occasionally, a CT scan is needed for very bad fractures to help determine if surgery is necessary.
Treatment – without surgery
It’s important to note that most fractures do not require surgery (http://www.ncbi.nlm.nih.gov/pubmed/24005198). A nondisplaced fracture does not generally require surgery. Nondisplaced means that the bone breaks, but does not move out of place. (Think of it as a crack). In this case, the treatment is simply pain medication and a sling for a brief period for comfort and support.
If you’re using a sling, it’s important to keep moving arm to prevent the shoulder from getting frozen. Ask your doctor or physical therapists for exercises. Generally, you can begin working on increasing movement at the shoulder at 2-4 weeks. From 6-8 weeks you can work on strength training. Usually, a person cannot return to contact sports for 8-12 weeks after the injury, but this depends on the fracture and the healing pattern. Some athletes have been able to return to sports after 6 weeks, depending on the sport and the healing process.
Treatment – with surgery
Displaced fractures sometimes require surgery, although not ALL displaced fractures require surgery. Displaced means that the bone breaks and moves away from it’s normal position. Usually the section of the bone closest to the neck moves up and the section of the bone closest to the shoulder moves down. This may create a bump you can feel. This movement can shorten the overall length of the bone. If the length becomes more than 2cm shorter, surgery may be necessary. In someone young and active, this is very important because the loss of length leads to decreased shoulder strength and decreased endurance. However, it’s important to note that if the bone moves less than 2 cm, surgery is generally not indicated.There are multiple ways to fix a clavicle fracture. The most common way is by putting a plate and nails around the bone. Sometimes, the surgeon may opt to put a rod through the bone to stabilize the fracture.
What happens after surgery? A sling can be used for a brief period for comfort and support, followed by range of motion exercises at 2-4 weeks. From 6 weeks on strengthening exercises can occur. The patient can return to sports from 8-12 weeks following the surgery. Some papers have described return to sports as early as 6 weeks (http://www.ncbi.nlm.nih.gov/pubmed/23982401) but this is uncommon.
If you have questions about clavicle fractures or want an opinion to see if you need surgery, call Regional Orthopedics.
