Open Reduction and Internal Fixation Clavicle Fractures
The clavicle is a bone that attaches the shoulder and arm to your central body. There are 3 different places that the clavicle can break. The most common area is in the center of the bone – called a midshaft clavicle fracture. The second most common area is at the end of the bone by the shoulder – called a distal clavicle fracture. The third area that the clavicle can break at is near the sternum – also called a medial clavicular fracture.
Most midshaft clavicle fractures can be treated without surgery in a sling and a figure of 8 harness brace. Occasionally the fracture is angulated or shortened enough that surgery needs to be done to stabilize the fragments. Typically a plate and screw construct is needed to provide support to the bone for healing.
The surgery for fixation of a clavicle fracture is typically an outpatient procedure. You will receive a general anesthetic, in addition to a nerve block to your operative side. The nerve block is placed by the anesthesia service and allows you to wake up relatively pain-free. The block lasts for approximately 12-18 hours, after which you can start easing into your pain medication. Some clavicle fractures are difficult to manage with a nerve block because the location of the broken bone and the incision are not covered by the block. In those cases we also supplement the pain medication with an injection of lidocaine to your incision during surgery.
During surgery, you are positioned into a “beach chair” position, with all of your extremities carefully padded. Your head is also supported in a padded head holder. After performing a “time out”, where we verify the operative site, your clavicle area and arm are cleaned and sterilely draped. We make the incision just off the clavicle bone, centered over the fracture. We carefully dissect down to the bone, but occasionally there are some skin nerves that can get injured. We take our time to preserve these nerves, but due to anatomic differences between each patient occasionally they need to be cut. The nerves do not hook up to any muscle but provide some sensation just over the clavicle bone.
Once the fracture site had been identified, the ends of the bone are aligned and a plate and screw construct is placed to hold the pieces together. X-ray is used during the procedure to verify the reduction of the fracture and in placement of the plate.
The incision is closed and a sterile dressing is placed over the wound. Occasionally we use a drain in the shoulder to help remove some of the swelling, but this is very rare. Your arm is placed in a sling and pillow device for immobilization. It is very important that you stay in the sling and pillow and adhere to the rehabilitation protocol.
Sometimes we move the shoulder very quickly after the procedure, but other times we keep you in the sling for a couple of weeks prior to even moving the shoulder. This will be explained to you after the procedure and very specific instructions will be given to you and your therapist.
Once your pain is under control, you are eating and keeping food down, and you are medically stable, you can be discharged home. You will get a full set of instructions of Do’s and Don’ts. Basically, make sure to keep your incision clean and dry. No showering until your postoperative visit. If you have any questions on what you should be doing or not doing to your shoulder, make sure to ask your surgeon or the nurses/residents. You will be seen in the office for a check up and to remove any staples or sutures in 7 – 10 days after surgery. You will also be given a pain medication prescription. Please take the pain medication as directed. Eat a healthy diet and get plenty of rest. Also remember that ICE is a form of pain relief and you should ice the shoulder and clavicle regularly.
Typically you are in the sling for 6 weeks after surgery but are coming out of the sling for very prescribed movements that you will be taught. Physical therapy is an important part of the rehabilitation but depending on how bad your clavicle fracture was, your therapy may be delayed so your reconstruction can heal.
We hope this provides a bit more insight into your surgical procedure for open reduction and internal fixation of the clavicle. As always, if you have any questions, please contact our office at 248-988-8085.