Fracture > Treatments
Open Reduction and Internal Fixation
You may be a
candidate for open reduction and internal fixation to
repair your fractured collarbone if the fracture occurred
in the outer (distal) third of the bone, closer to your
acromioclavicular (AC) joint. You may also need this
surgery if your fracture did not heal properly during
immobilization. In this procedure, the fracture is fixed
in place by wires and sutures or plates and screws.
The decisions you make and the actions
you take before surgery can be every bit as important
as the procedure itself in ensuring a healthy recovery.
Getting a second opinion from another qualified surgeon
is often advisable, particularly in rare or unique cases.
sure you have received any equipment you will need when
you get home from the hospital. This may include a shoulder
sling, ice packs or coolers, or heating pads. You should
receive prescriptions for any of these from your doctor
when your surgery is scheduled.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
others who have undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
possible, discontinue the use of any anti–inflammatory
medicine, especially aspirin, a week prior to surgery,
to prevent excessive bleeding during the procedure.
reduce the risk of infection, improve healing, and decrease
complications, try to quit smoking or decrease the amount
you smoke. In general, smokers have a higher infection
and overall complication rate.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will
go to "patient admissions" to check in for
your open reduction and internal fixation of your collarbone
fracture. There may be separate check-in areas for ambulatory
outpatient (patients who go home the same day after
surgery) and for overnight inpatient surgery, so be
sure to ask your physician or an assistant about this.
After you have checked in to the hospital or clinic,
you will go to a holding area where the final preparations
are made. The paperwork is completed and your shoulder
may be shaved, though this is not always necessary.
You will wear a hospital gown and, if applicable, remove
your watch, glasses, dentures, and jewelry. You will
have the opportunity to speak with your orthopedic surgeon
or an assistant, and meet the anesthesiologist or anesthetist
(a nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under anesthesia.
you may be unable to drive, arrange for someone to help
take you out of the hospital and drive you home when
you are released.
a soft, comfortable shirt that will not irritate your
skin when worn under a shoulder sling.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Open reduction and internal fixation
of your fractured collarbone can take between one and
two hours to perform.
arriving in the operating room, the anesthesiologist
will begin intravenous sedation and often a regional
anesthetic will be given. The patient may then be given
a general anesthetic, depending on what pre-surgery
decisions have been made.
incision is made to access the fractured part of the
surgeon will use plates and either screws or sutures
to fixate the broken bone, depending on the pattern
of the fracture.
incision is then closed and the patient is taken to
the recovery room.
When you awaken in the recovery room
following open reduction and internal fixation of your
collarbone fracture, your shoulder usually is wrapped
in gauze, immobilized in a sling, and covered with an
ice pack. You may feel a moderate amount of pain. You
usually stay in the recovery room for at least two hours
while the anesthetic wears off. General anesthesia wears
off in about an hour and regional anesthesia may take
about two hours to wear off. You should try to move
your fingers while you are in the recovery room to improve
circulation. Moving your wrist may be painful, and you
usually should not try to move your elbow. Your temperature,
blood pressure, and heartbeat will be monitored by a
nurse, who, with the assistance of the doctor, will
determine when you are ready to leave the hospital or,
if necessary, be admitted for an overnight stay.
After open reduction and internal
fixation of a collarbone fracture, some patients remain
in the hospital for as long as 24 hours. There will
likely be pain, and you can expect to be given pain
medication as needed. Be sure to ask for medication
as soon as you feel pain coming on, because pain medication
works best on pain that is building rather than on pain
that is already present. The nurses will not give you
more than your doctor has prescribed and what is considered
to be safe. Ice also helps control pain and swelling.
Physicians generally suggest that you immobilize your
shoulder in a sling for about six to eight weeks. You
will be taught how remove the sling and bend your elbow
if necessary. In addition, you will be given an appointment
to return and a prescription for pain medicine. You
will not be able to drive, so be sure to have arranged
for a ride home.
open reduction and internal fixation of a collarbone
fracture, you will need to take steps to reduce the
pain and inflammation in your shoulder. Rest, icing,
and anti-inflammatory painkillers such as ibuprofen
or aspirin can ease pain and swelling, and immobilizing
the shoulder will keep it stabilized. Here is what you
can expect and how you can cope with a sling immobilizing
first concern is to monitor swelling for the first 48
hours while wearing your sling. Physicians generally
prescribe ice packs to be applied for 20 minutes at
a time, three or four times a day.
may be some minor drainage on the bandage since fluid
may have accumulated during the surgery. Expect some
blood to show through the bandage during the first 24
to 48 hours.
generally recommend that you wear the sling day and
night for between two and eight weeks.
can usually remove the gauze bandage and bathe regularly
after two to seven days. Call your physician if bleeding
continues. You can remove the sling for brief periods
to shower, but remember to avoid moving the injured
are usually removed about two weeks after surgery.
your shoulder starts to heal, your physician may recommend
that you remove the sling for short periods to perform
some light, early-motion exercises.
should move your fingers and hands in the sling as much
as possible to help circulate blood.
you develop a rash or irritated skin around your sling,
call your physician.
you notice any abnormal wear or discomfort in the sling,
contact your physician as early as possible. In general,
do not try to "grin and bear it" if discomfort
does not go away within a few days. The sling should
not irritate your skin.
Rehabilitation can usually begin within a few weeks
after surgery, but you should visit your physician a
week after the injury for a check-up. Until cleared
by your physician, you should keep the shoulder immobilized
in the sling. The sling may make it difficult to use
the hand of the injured shoulder, and you may need to
take several weeks off from work, depending on how much
you rely on the immobilized hand.
After about two or three weeks of
immobilization, your physician usually refers you to
a physical therapist to begin rehabilitation exercises.
The first stage of physical therapy usually involves
passive motion exercises with the assistance of your
physical therapist. Most patients begin with forward
motion in the shoulder. Because your arm has been held
across your chest for weeks, rotating or turning the
shoulder outward is usually painful when rehab begins.
With the shoulder held in place, you usually begin strengthening
your wrist and elbow by flexing and extending your hand
and arm. After two to four weeks, you may be able to
start moving your hand, arm, and shoulder without the
assistance of the therapist. Usually within eight weeks,
your therapist can start adding resistance to your exercises
with weights or elastic bands. Non-contact sports, like
tennis and swimming, can often be resumed within four
months. Contact sports should usually not be resumed
until at least six months. Depending on your specific
situation, your physician may prescribe a modification
to the above regimen.
Though injuries caused by direct trauma
frequently are difficult to avoid, you can help reduce
your risk of repeat collarbone injuries by making shoulder
strengthening exercises part of your everyday routine.
Rotator cuff strengthening helps reduce the risk of
overuse problems during athletic or work activities
that require repetitive overhead motions. For players
in contact sports like football, hockey, or lacrosse,
wearing well-fitted shoulder pads that provide more
cushioning can help prevent direct-blow collarbone injuries.
Indirect injuries, such as accidentally falling on your
hand, are more difficult to prevent. After a collarbone
injury, you should be careful to notice any pain or
discomfort in your shoulder during athletics. Avoid
playing through shoulder pain.