Clavicle Fractures: To fix or not?


by Harry Brownlow, October 2017

Really interested to see the London group publish their much anticipated study on clavicle (collarbone) fracture management (JBJS Jan 18, 2017) . They repeated an influential Canadian study from 10 years ago but with much bigger numbers (JBJS Jan 2007). Their results were identical! Patients with clavicle fractures were randomly allocated to either being treated with a sling for comfort (traditional non operative treatment) or having an operation to apply a plate (ORIF). By all criteria those patients who had an operation did much better: they returned to work quicker, they returned to sport quicker, they had better clinical outcome scores up to 9 months after surgery, they were happier with their cosmetic result, and it was more likely that the bone would heal. The complication rate after this type of surgery was also very low. However by 9 months after surgery there was not much difference between the two groups.

Clavicle Fractures: To fix or not?
So if you want to get back to normal life as quickly as possible after this type of injury then choose the operation. If you are in no rush or if you are disinclined towards surgery then you will still do very well in the long run.
Modern improvements in anaesthetic, pain management, surgical implants and surgical technique all mean that surgery for a clavicle fracture can usually be performed as daycase surgery under general anaesthetic. You could expect to get rid of the sling within a day or two and be back at work and driving within a week. I would not allow you to return to heavy or collision sport until the collar bone had healed on the xray, which might take between 2 to 3 months.

New RCT Data on Midshaft Clavicular Fractures