Types of Fractures
Fractures of the clavicle are a common clinical problem with over 200,000 cases per year. Clavicle fractures are divided into three groups – lateral (distal), midshaft, and medial. Most fractures are not displaced and therefore can be treated without the need for surgery. A sling is provided for comfort and is necessary for anywhere from a few days to a few weeks. Within 2-3 weeks the fracture site get “sticky” and pain subsides considerably allowing rehabilitation to begin. Full activity can generally begin within 4-6 weeks and contact sports within 3 months.
Distal Clavicle Fractures
Fractures involving the distal clavicle account for one-fifth of all clavicle fractures. While the majority of these fractures are non-displaced, a significant number are displaced and require surgery. When the fracture is displaced there is a very high risk that the fracture will not heal and cause ongoing pain and dysfunction if not treated surgical. The weight of the arm pulls the small distal fragment away from the main clavicle and scar tissue form in between the fracture fragments preventing healing. The result is a what is termed a “non-union”. This problem is similar to an AC joint dislocation as the ligaments connecting the clavicle to the scapular are also torn. This contributes to the overall problem of the fracture fragments being widely separated. Successful surgery requires not only connecting the two fracture fragments but also restoring the ligaments as well.
Traditionally plates and screws have been used to surgically repair distal clavicle fractures but although this approach is very successful it requires a second operation to remove the hardware once the fracture has healed. The Closed Loop Double Endobutton technique that is used for AC joint dislocations has also been applied to the treatment for displaced distal clavicle fractures. This not only has resulted in consistent and reliable fracture healing and full return to activity but does not require a second surgical procedure. Dr. Struhl’s patented technique has recently been published in the Orthopedic Journal of Sports Medicine.
Fractures involving the middle of the clavicle frequently require surgery as well if the fracture fragments are significantly displaced. Signficant displacement is often associated with significant pain and the sharp fracture edges dig into sensitive surrounding soft tissue. In addition deformity from malalignment is both cosmetically and functionally unacceptable for many patients. In many cases the length of the clavicle is significantly shortened and this rotates the shoulder blade permanently causes a new set of problems, termed scapular dyskinesia. Prevention of both short term and long term problems of displaced midshaft fractures can be assured with early surgical intervention with fixation with a specially designed contoured clavicle plate. This ensures fracture healing and significantly reduces pain during the healing process. Full return to activity can be expected once the fracture heals.