Hi, I broke my right collar bone 11 weeks ago in a car accident. Apart from the initial x-ray and diagnosis, I have had no futher treatment for it. I was not told (or put) to wear any kind of sling. I've just been left. Eleven weeks on, I'm still in discomfort. I can't sleep on my right side, I find driving difficult (as the seat belt goes across the injury), after long walks it becomes very achey. I even find sitting upright uncomfortable, as it almost feels like the bone is being pushed forward. I can still feel the lump and it's visibile. Is all this normal? I was told collar bones heal themselves, and medically there isn't much that can be done. But I'm wondering if things should be healed by now?
Thanks for any help.
Treatment of clavicle fractures depends greatly upon where the break is.
Fractures in the midshaft, which are minimally displaced, are usually left to heal on their own. In adults, usually a sling for a few days, followed by physical therapy is about all that is needed. Adults do not tolerate a figure-8 splint very well.
Fractures that involve the distal end are a little more complicated. Depending upon whether or not the coricoclavicular ligaments are injured and if the AC joint is involved, makes the treatment much different. Usually, these are treated surgically.
The trend in the treatment of midshaft fractures is changing however. It used to be felt that fractures that are greatly angulated or even those which are complete and overlapping could be treated nonoperatively. That the shortening which occurred did not cause any problems. The bump was cosmetic and did not need any treatment.
In the past few years, more and more clavicle fractures are being treated operatvely. But, that is not to say that the consensus is complete, because many, many orthopedic surgeons still feel that operating on clavicle fractures is not needed and posses too many risks.
But, again, many do feel that the clavicle should be reduced anatomically and plated (in most cases). There are many risks associated with this surgery. The great vessels are just below the clavicle and can be injured. There is a large sensory nerve that goes across the midshaft clavicle region. If damaged, it can cause numbness and/or pain on the chest to include the nipple. Since there is little subQ tissue on the clavicle, the plate is always proud. In the majority of cases the plate has to be taken out after the fracture heals and that is another surgical procedure. And of course, there is the scar and the chance of infection any time you do surgery. Besides all of the usual risks of any surgery.
So, you are about 3 months out from your fracture. The bone should be healed. The bump is both the bone and the callus (new bone) the body formed to glue the fracture back together. The callus will remodel some, but the bump will probably be there is some manner the rest of your life.
You should be doing therapy to get your shoulder range of motion and strength back. It does not have to be formal PT, most patients can do it on their own. It usually takes about 6 to 8 months to completely rehab a clavicle fracture.
However, if you feel that the problem is impacting greatly on your ability to get the rehab done that is necessary for you to get over this injury, then you should see an orthopedic surgeon.
You should at least have some new x-rays taken to make sure the fracture has healed adequately. Then you can discuss your options with the surgeon.