It was a little nerve wracking waiting almost two days to get an X-ray of my shoulder. At first I was certain of the diagnosis, but doubt and worry crept in over time. Luckily the X-ray showed the most common type of clavicular fracture (about 80%), a complete break in the middle of the bone.
It is worth mentioning, in regards to skipping the ER, the bone end was visible beneath the skin and there was some ‘tenting’. For clavicle fractures, there is only urgent concern if the skin is tight enough to blanch white from the tension, which mine did not.
I consider myself lucky I didn’t hurt myself worse. The shoulder joint is very complex and I know that some injuries can have six month recoveries, and others (low grade AC Separation) aren’t treatable and cause permanent change in shoulder function. A broken clavicle is straightforward and the main options are to let it heal, or surgery to pin it back together.
Clavicle fractures used to almost always be left to heal with the shoulder in a sling or brace for about 8 weeks. There are still advantages to this method: Lower cost, no scarring, and no risk of surgical complications. The main risks are non-union (when the bones don’t grow together) and malunion (when they grow together in the wrong place, leaving a large bump or impairing shoulder function). In my case, the bones will likely heal. But like all clavicle fractures, the position of the broken bones is difficult to change due to the large number of muscle/tendon attachments.
Surgery is an option if there are multiple fragments (I have one small, long triangular piece near the bottom of the fracture, but my doctor wasn’t too worried about it) or the displacement is too great. Surgery leads to earlier use of the arm, less risk of non/malunion, and slightly improved shoulder function at one year. It is much more expensive and has associated surgical complication risk. Also the hardware may cause irritation and need to be removed later.
In my case, the degree of displacement was key. While the bone ends were only just over 10mm apart, there was just over 20mm of total displacement (measuring from bone top to bone top). While I had the option of either surgical or non-surgical treatment, we decided surgery would leave me with better arm/shoulder function, and get me there faster.