If you and your surgeon have decided that your clavicle fracture requires surgery, this is normally achieved using a clavicle-specific plate and screws. Occasionally the plate construct is augmented by a ligament repair in lateral clavicle fractures, where the bone for fixation is very small or fragmented.
Clavicle fixation is normally performed as a day-case operation under general anaesthesia and sometimes with additional regional nerve block.
An incision is made over your broken bone. The orientation of the incision is usually designed to give you the best scar, whilst also allowing your surgeon access to the broken bone. In the midshaft this is usually an oblique incision, but more laterally it is more over-the-top where a bra strap might lie in a lady.
There are small sensory nerves just beneath the skin over your collarbone then these are cut as part of the surgery. This means you will have a numb patch below, or lateral to your incision. This patch tends to shrink with time and is rarely a problem for patients.
Your bone is then reduced (put back into the correct shape) and fixed with the plate and screws. Sometimes extra screws that don't go through the plate are used as well. Your wound is closed with dissolving sutures and covered with a dressing.
X-ray of a fixed midshaft collarbone fracture - a clavicle-specific low-profile plate was used
Lateral clavicle plate with ligament repair augmentation (note the button beneath the coracoid process of the shoulder blade). This holds sutures which are helping to hold down the plate on the bone.
The complication rate is low, but there are specific risks of fixation that you need to be aware of.
Bleeding – there are major blood vessels that run just behind and beneath your collarbone. It is very rare for these to get injured, but if it does happen, major bleeding, or air embolism can occur. There are extremely rare case reports of fatalities from clavicle surgery.
Nerve injury – you will get a numb patch beneath and lateral to your scar where sensory nerves are cut in the incision. Major nerve injury affecting function in your arm is extremely rare, but slightly more likely in revision and non union surgery, where scar tissue can tether the nerves.
Lung injury – the top of your lung lies just behind your collarbone. It is very rare for the lung to get punctured. If it does happen you may need a chest tube to help re- inflate the lung.
Infection – as for all surgery, there is a small chance of infection (approx. 1-2%) which sometimes requires further surgery.
Failure of healing or fixation is rare (<5%) after fixation. If it does happen, revision surgery may be required.
You will wake up in a polysling and usually go home the same day. Please take your painkillers regularly for the first few days and begin them before your nerve block wears off. Normally you will feel your shoulder is much better pretty quickly. Please leave your dressing on until your clinic appointment at 2 weeks, when your wound will be inspected and any suture ends trimmed. You will also have an x-ray. You can begin gentle shoulder motion immediately, but do not do anything heavy for at least 8 weeks.
Patients vary in their recovery, but you can expect to return to:
Office Work – 2 weeks
Light manual work 6-8 weeks
Heavy manual work 12-18 weeks
Driving is allowed once you are confident and competent to control your vehicle for routine and emergency manoeuvres. This usually takes a few weeks