Oct 26, 2018

Interview Transcript

Dr. Miller: You have a broken collarbone or a fractured clavicle? Do you need to have the treated surgically or can it heal naturally?

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. "The Specialists" with Dr. Tom Miller is on the Scope.

Dr. Miller: I'm here Dr. Bruce Thomas. He is an orthopedic surgeon here at the University of Utah in the Department of Orthopedics. Bruce, tell us a little bit about fractured clavicles.

Dr. Thomas: Fractured clavicles are a common sports injury, men more than women, and the treatment of it has evolved over the years. Traditionally, many of them were treated without surgery and the rate of non-healing was about 3%.

Dr. Miller: Before we get into that, how does one fracture a clavicle or bust the collarbone as they say on the athletic field?

Dr. Thomas: Usually, it's a fall to the shoulder.

Dr. Miller: Outstretched hand, that sort of thing?

Dr. Thomas: Mostly, not outstretched. More to the point of the shoulder and occasionally from blunt trauma. But usually, it's a fall to the shoulder or a side impact.

Dr. Miller: Mostly seen in contact sports like football?

Dr. Thomas: Contact sports, you see it in soccer and skiing as well. The contact with the ground is usually the contact. Most of the collarbone fractures occur in the shaft and in the mid portion of it and the smaller percentage will occur way out towards the end of the clavicle near the shoulder. Those require treatment almost uniformly. The ones in the shaft, less, less uniform require treatment.

Dr. Miller: So does it matter what type of an athlete you are? Might you consider surgery to get back into the playing field sooner in some cases?

Dr. Thomas: They're finding it definitely affects the biomechanics. Traditionally, you would accept 2.5 centimeters of shortening before you would consider surgery and now, the number is about 1 centimeter. And keeping that strut at the right length helps in the position of your shoulder and the movement of your shoulder blade.

Dr. Miller: So if it doesn't heal appropriately or if the distance between the fracture is, you know, there is a gap I guess, then you could lose function or sacrifice some function in the shoulder?

Dr. Thomas: You could. Without a nice, strong strut there as you load the shoulder, you'll feel weakness. But interestingly, the older literature shows that half of the patients that have a non-union don't have a lot of symptoms. But that could be depending on what their activity is.

Dr. Miller: What their activity level is. So kind of who you are matters in terms of whether you might consider surgery. So I guess it's a bit of a personal decision and you as the orthopedic surgeon explain that to the patient.

Dr. Thomas: That's true. And what your demands are make a big difference on whether you need surgery or not.

Dr. Miller: And so how do you repair the clavicle? Do you put a plate in or do you just . . . I mean, it's kind of hard to put a cast on the shoulder, obviously.

Dr. Thomas: That's true. And so, the hardware serves as an internal cast and supports the bone and keeps it aligned while it heals. And most commonly is used a plate, either on the top of the collarbone or on the front of the collarbone.

Dr. Miller: And you leave that in after the period of healing?

Dr. Thomas: On the top, eventually the bone heals, the swelling goes away. And on top, there's not much tissue between the collarbone and the skin. And those are kind of prominent and people will feel them with their seatbelts or backpacks. And so if the plate is on top, it's more likely to be removed later.

Dr. Miller: So would you say that anyone who has a clavicular fracture should probably see an orthopedic surgeon and discuss the reason for her need for surgery or healing?

Dr. Thomas: I think that's a great rule and especially if you're in high demand sports or heavy activities, making sure that your strut is the right length and ensuring healing is important.

Dr. Miller: Once you fracture a clavicle, whether it's plated or not, how long is the period of healing, generally?

Dr. Thomas: It varies, obviously. In young children, it will very quickly, four to six weeks. Adults, six to eight weeks, usually, and a small number up to 12 weeks.

Dr. Miller: And so physical therapy, is that any part of the rehabilitation of the shoulder or clavicle, rather?

Dr. Thomas: It certainly is. People tend to get stiff when you immobilize them or after a surgery. And as the fracture becomes more stable, early motion helps reduce the amount of stiffness and aids people getting back to their activities quicker.

Dr. Miller: So generally, somebody who's been injured in a sports-related activity or at work, they would know if they had a fracture. I mean it's painful, it's prominent. You can see the changes because the bone is so close to the skin.

Dr. Thomas: That's true. Most of the time, they know instantly and pretty quickly, everyone around them can tell as well.

Dr. Miller: So bottom line, then, for our listeners would be that if you have a clavicle fracture, called the collarbone in everyday usage, but if you have a fracture, you should probably see an orthopedic surgeon and have that evaluated because surgery might assist you in healing. And a certain percentage of patients will go on to surgery and have a good result.

Dr. Thomas: That's true.

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