Adam Rufa - 4/10/2006

Question
To whom it may concern:

  Three weeks ago, I slipped and fell about eight feet onto a concrete patio--landing directly on the upper-right area of my shoulder blade and fracturing my right clavicle.  X-rays taken immediately after the fall revealed no loose fragments.  
  The break is slightly closer to the sternum than it is to the shoulder.  Each half of the bone is basically parallel, but the ends do not meet.  Instead, they overlap by about an inch and are separated by a small gap (within a half-inch).
  I went to see an orthopedic surgeon to see if the alignment of the clavicle (as described above) could be improved without surgery.  He said that, even with a figure-of-eight strap, reduction could only be improved with surgery.
  I am writing to you in hopes that you can confirm this opinion and put my mind at ease.  Am I doing all I can to ensure proper healing?  Could closed reduction bring the broken ends of my collarbone closer together or would further treatment (besides surgery) be pointless?  In short, is this "as good as it gets" without surgery?  
  Thank you for responding.

Josh C., age 22.


Answer
Josh.

  A closed reduction may improve the alignment, however that would most likely be temporary. There are a few fairly large muscles that attach to the collar bone and pull in opposite directions. Those muscles will simply pull the fractured bones back apart. This same things happens with AC joint separation (shoulder separation).
  Basically there is not much you can do to correct this non-union without surgery. However, they often do not cause pain, so if you still have shoulder symptoms it may not be due to the fracture.  



Adam