When is surgery the best treatment option for broken collarbone?

[PowderPuff2022]

My teenage daughter broke her collarbone. Initially, the X-ray showed the fracture forming a peak. She had severe pain, but after several days the pain graduated to soreness. Then, while walking and carrying a glass of milk and package of cookies she started screaming in pain. For 12 hours she had spasms and shooting pain. She described it as worse than the initial break. A week later, her scheduled followup X-ray showed the bone had shifted. Her orthopedic specialist said that is what caused the spasms and shooting pain. The bone is now overlapping but with one part at an angle and the other wedged beneath. Recommendation we have been given is to allow it to heal naturally.

[specialmom]

So, she wasn't in a sling and instructed to immobilize the shoulder?  That's unfortunate! You wouldn't think just carrying a glass of milk though would result in a shift!  I have said here before that I am a proponent for not having surgery whenever possible. The least invasive approach to healing is often optimal.  However, there comes a point in which someone is NOT healing that surgery is more practical.  This is new and I'm not sure your daughter is there yet.

I'd give it two weeks.  I'd make sure to use the immobilization sling.  If it is not healing or improving and physical therapy with slight movement/stretching exercises are still very painful, see the doctor again.  You don't want this to get worse or have nerve issues at that point.  

How did she initially hurt her collarbone by the way?