collar bone surgery

[ashu007]

hi this is ashutosh. i met an accident and broken my left clavicle. Dr. suggested a support belt and asked me to wear it for eight weeks after which it was removed  . i was leading a normal life but after some time i found a increase in mass at the fracture location when interrogated i found that the bone was not united.so Dr. suggested me to undergo a surgery. now i want to know the riska involved with surgery, possible complications and success rate of such surgeries. it would be very kind if i can get a quick reply.

[JainMD]

Hi Ashutosh,
How are you feeling?
What was the initial plan of management?
The clavicle serves as the primary bony connection between the thorax and upper limb. A fracture of the clavicle also is known as a broken collarbone.
Where is the fracture, is it at proximal location, middle of clavicle or distal?
Is there any associated fracture of scapula?
Incidence wise it is one of the most common fractures (*) 5% involve the proximal 1/3 of the clavicle, 70% the middle 1/3, 25% the distal 1/3.
Did you consult physiotherapist for passive Range of Motion (ROM) exercises?
Physical therapy for early ROM of the shoulder (Codman exercise)
Most of these injuries can be managed non-operatively.
Surgery may be needed for displaced fractures in patients who are highly active or have jobs with overhead activity.
The most common treatment is open reduction and internal fixation with a plate and screws.
The plate may be placed superiorly, anteriorly, or antero-inferiorly.
Hardware irritation is common after surgery, requiring plate removal.
Pin fixation is a less invasive alternative.
Threaded screws or titanium flexible nails may be used.
A serious complication of pin fixation is migration of the pin into the intra-thoracic region.
Usually the pin must be removed after fracture healing.
Keep me informed.
Bye.

*- Robinson CM, Court-Brown CM, McQueen MM, et al. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg 2004;86A:1359 to1365.

[ashu007]

respected there,
greetings of the day,
location of fracture is middle 1/3. currently i am pursuing my MBA so i am planning to undergo a surgery in the month of april, i.e. after completion of my course. Any ways thanks for the information and i will update you with further developments.
with regards,
ashutosh

[JainMD]

Hi,
If you see the prognosis for fracture clavicle middle 1/3rd, the prognosis is good for patients with minimally displaced fractures.
Patients with displaced fractures develop a generally asymptomatic deformity from the fracture.
Functional deficits are unusual but can occur with markedly displaced fractures.
Return to full function should occur by 6 to 12 weeks.
The complications noted are Skin breakdown over the fracture site, Nonunion or malunion (may require future procedures to realign the bone and permit healing), Vascular injury, Nerve injury, Pneumothorax, and Residual pain.
Hope this information is helpful.
Keep me informed.
Bye.