ORIF Surgery for Clavicle Fracture

Surgery for a clavicle fracture is indicated when the bone fragments of the clavicle have become displaced. ORIF (open reduction internal fixation) surgery is done to realign and stabilize the bone fragments.

Clavicle Fracture

A clavicle fracture (broken collarbone) is a common fracture that affects people of all ages. Most breaks occur in the middle of the bone (the midshaft). Sometimes the bone will break near its attachment at the shoulder blade laterally or the sternum medially.

A clavicle fracture frequently results in an obvious deformity at the fracture site where the broken ends of the bones cause tenting of the skin. Patients with clavicle fractures often describe the sensation of the fracture fragments moving or grinding together with movements of the shoulder or arm (this is called “crepitus”).

Shoulder Anatomy

The shoulder is made of three bones: the humerus (upper arm bone), the clavicle (collarbone), and the scapula (shoulder blade). The humerus and scapula join at the glenohumeral joint. This joint is held together by a group of muscles and tendons called the rotator cuff. The clavicle is located at the front of the shoulder girdle and it acts as a strut, connecting the arm to the body. It is attached (via the AC joint) to a part of the scapula called the acromion (AC joint = acromioclavicular joint).

Causes of a Clavicle Fracture

Clavicle fractures are most often caused by a direct blow to the shoulder, which can happen during a fall onto the shoulder, a fall onto an outstretched arm, or in a car collision or bicycle accident.

Patients with a clavicle fracture experience the sudden onset of severe pain and have trouble lifting their arms due to pain.

When to Call a Doctor

If you have broken your clavicle or have injured your shoulder and suspect you may have a clavicle fracture, call Dr. Sara Jurek for a consultation:

Common symptoms of a clavicle fracture include:

Severe pain
Sagging of the shoulder downward and forward
Inability to lift the arm because of pain
A grinding sensation when you try to raise the arm
A deformity or bump over the break
Bruising, swelling, and tenderness over the collarbone

Diagnosing a Clavicle Fracture

Medical History. Dr. Jurek will discuss the details of your injury; when and how it happened.

Physical Exam. She will perform a careful exam of your shoulder (including your clavicle) to confirm the diagnosis.

Imaging Studies. An x-ray of the clavicle will be ordered to visualize the fracture. If necessary, Dr. Jurek will order a CT (computerized tomography) scan to see the extent of the fracture in more detail.

Treatment Options for a Clavicle Fracture

Treatment of a clavicle fracture depends upon the severity of the injury. Many broken collarbones heal well without surgery.

Nonsurgical Treatment. If the bones have not significantly shifted out of place, the fracture may be treated with a sling, pain medication, and physical therapy once the fracture has adequately healed. Physical therapy starts with gentle range of motion shoulder exercises followed by strengthening exercises.

Follow-Up Care. During your recovery, you will see Dr. Jurek in clinic for x-rays to ensure that your clavicle is healing in good alignment.

Surgical Treatment. If the broken ends of the bones have become significantly displaced, ORIF surgery may be necessary to position the fracture fragments back into anatomic position (that’s the “open reduction” part of ORIF) and then stabilize them (that’s the “internal fixation” part of ORIF) while they heal. During the procedure, an incision is made and the fracture fragments are positioned (reduced) into their normal alignment. A metal plate and screws are then attached to the outer surface of the clavicle to hold it in place while it heals. X-rays are performed during the surgery to verify the correct alignment of the bones and the position of the plates and screws.
Plates and screws are not routinely removed after the clavicle heals but can be removed once the fracture is completely healed if they are causing discomfort.

Recovery from ORIF Surgery for Clavicle Fracture

After surgery, your arm will be placed in a sling, and Dr. Jurek will have you start gentle shoulder range of motion exercises a few days after surgery. You may start moving your elbow, wrist, and fingers right away. Use cold therapy to help with postoperative pain and take pain medication as directed.

Recovery from ORIF surgery for a clavicle fracture can take 6-12 weeks for the bone to heal fully. You can expect to begin physical therapy to regain shoulder range of motion within 2-4 weeks after surgery. Strengthening exercises are added gradually as your healing progresses.

Most patients are able to return to normal activities within 3-4 months.

Risks of ORIF Surgery for Clavicle Fracture

As with any surgery, there are risks of clavicle fracture surgery, including

Infection
Injury to blood vessels or nerves
Delayed bone healing or failure of the bone to heal
Problems with wound healing
Hardware irritation (from plates and screws)
Persistent skin numbness adjacent to the incision
Reaction to anesthesia
Lung injury
DVT (blood clot) or PE (pulmonary embolism)

Patients who smoke or have poorly controlled diabetes are at a higher risk for complications such as infection and delay or failure of healing of the fracture after surgery.

Dr. Jurek will talk about these risks during your consultation and explain the specific measures that can be taken to avoid such complications.