Question:
How do I know when a surgery for broken clavicle is in order? I broke the clavicle almost 6 mnths ago; xrays show "non union", dr suggests surgery but is leaving it up to me. I am in fitness, though I have improved immensley, I am still not completely healed. The entire shoulder girth feels compromised, push ups are still very painful as are chest presses, etc...more irritating currently is the obnoxious neck pain I am experiencing on the opposite side. This is getting worse, not better. I am 48 yrs old and realize bone healing is more difficult for older people but..I had a bone scan (dexa) 2 yrs ago and have 150% density of a 26 yr old. I am extremely fit and active. I was told I did too much too soon causing the bone to seperate?? Is this possible? Please help me make a decision whether to have surgery or not.



Answer:
The decision on whether to have surgery or not for a clavicle fracture or non union is a difficult one. It is important to recognize that: #1 Surgery is not necessary, as in appendicitis, but rather a choice... and #2 Most clavicle fractures go on to heal using closed treatment (limited immobilization with a sling, or brace, and early range of motion exercises). If you are able to perform activities of daily living comfortably (including sleep, self-care) etc., then the decision depends on how important the other things are to you: chest presses, etc. Only you can decide. As far as the neck pain you are experiencing... there is no question that a clavicle fracture affects the overall posture of your arms. Not just the arm on the side of the fracture, but both arms. The clavicle is the strut that connects your arm to your axial skeleton (spinal column and ribs). When it is fractured, the muscles of your shoulder, back, and chest wall function differently. This can lead to neck and back and shoulder pain (especially at the back of the shoulders). Some patients experience these symptoms more than others, and if you are experiencing these after six months, and serial radiographs show no further improvement (that is, you're heading for a nonunion), then surgery to fix the clavicle fracture may be the right answer for you. Two more comments.... the remark that you did too much too soon is probably not appropriate. One of the tenets of recovery after clavicle fractures is to emphasize early range of motion, lest the shoulder become stiff. Activites of daily living are often encouraged, as soon as patients tolerate these. Lastly, your age and bone density are not as important as the amount of initial displacement (energy of the initial injury) in determining the likelihood of eventual healing.