ORIF of Clavicle Fracture

A clavicle fracture—commonly known as a broken collarbone—is a frequent injury, especially among active individuals and athletes. These fractures often occur from falls, road accidents, or direct impact to the shoulder area. While some clavicle fractures can be managed without surgery, others require a surgical approach called Open Reduction and Internal Fixation (ORIF) to restore function and promote healing.

Understanding the Clavicle and Midshaft Fractures

The clavicle, or collarbone, is a slender bone that connects the breastbone (sternum) to the shoulder blade (scapula). Most clavicle fractures happen in the middle third, known as the midshaft, because it’s the weakest and most exposed part of the bone.

When this area breaks and the bone fragments are significantly out of place (displaced), surgery may be necessary. Without surgical treatment, patients may face problems like persistent pain, visible deformity, decreased shoulder strength, and difficulty sleeping on the affected side.

What Is ORIF?

Open Reduction means the surgeon makes an incision to realign the broken bone segments into their proper position.
Internal Fixation refers to the use of medical hardware—typically a plate and screws—to hold the bone in place during healing.

This procedure aims to:

• Restore the clavicle’s normal shape and length
• Reduce pain
• Improve shoulder strength and function
• Allow early movement and faster return to activity

When Is ORIF Recommended?

While many clavicle fractures heal well with a sling and rest, surgery is often advised when:

• The fracture is severely displaced
• There is a risk of the bone healing in the wrong position (malunion)
• The bone fails to heal altogether (nonunion)
• There are multiple bone fragments (comminuted fracture)
• The patient is young and active and desires a faster return to full function

How the Surgery Is Performed

The procedure is typically done under general anesthesia. Here’s a simplified overview of what to expect:

1. Incision: A curved incision is made over the broken clavicle.
2. Reduction: The bone fragments are realigned into their natural position.
3. Fixation: A metal plate is placed along the top of the clavicle and secured with screws.
   • In simple fractures, compression is used to hold the bones tightly together.
   • In comminuted fractures (with several fragments), a technique called “bridge plating” is used to stabilize the entire area without disturbing smaller pieces.
4. Closure: The surrounding tissues are stitched in layers, and the skin is closed.
5. Postoperative Care: A sling is applied for comfort, usually for two weeks.

Recovery and Rehabilitation

• First 2 weeks: You’ll wear a sling to support the arm and minimize movement. Pain and swelling are managed with medication.
• After 2 weeks: Sutures are typically removed. Light shoulder movement may begin under guidance.
• After 6 weeks: Most patients regain significant function and begin more active physiotherapy.
• By 6 months: Most individuals return to normal daily activity and often sports or physical jobs.

The goal is to restore shoulder strength, range of motion, and function with minimal long-term discomfort.

Common Symptoms After Surgery

Mild discomfort, swelling, or tightness around the surgical site is expected early on. You may also notice:

• Temporary numbness over the incision site, which typically resolves
• Sensation of hardware, especially in lean individuals

Possible Complications

While ORIF has a high success rate, like all surgeries, it carries potential risks. Commonly reported complications include:

• Adhesive capsulitis (frozen shoulder) – Stiffness in the shoulder joint, especially if movement is delayed. This is typically addressed through physical therapy.
• Paresthesia – Tingling or numbness over the surgical site, often due to minor nerve irritation.
• Infection – A small risk that is usually limited to the skin and treated with antibiotics.

In most cases, these issues are mild and short-lived.

Why ORIF Can Be the Right Choice

Patients who undergo ORIF for midshaft clavicle fractures often report:

• Faster pain relief
• Earlier return to daily and athletic activities
• Better cosmetic outcomes
• Improved shoulder strength and alignment

Additionally, surgery helps restore the natural curve and length of the clavicle, which is important for shoulder balance and performance.

What to Expect at Follow-Up Visits

You’ll return to your surgeon at regular intervals after surgery to check healing progress. X-rays are taken to confirm that the bone is uniting properly. Your recovery may include:

• Adjusting your activity level
• Working with a physiotherapist
• Monitoring any hardware-related discomfort (rarely, hardware may be removed if it causes ongoing irritation)

Final Thoughts for Patients

ORIF for clavicle fractures is a safe and effective procedure when non-surgical treatment isn’t sufficient. With proper surgical care and rehabilitation, most patients regain full use of their shoulder and resume an active lifestyle.

If you’ve been told you need ORIF for a clavicle fracture, ask your surgeon about:

• The type of fracture you have
• The implants being used (often a pre-shaped “locking plate” designed to fit your clavicle)
• Your personalized recovery timeline
• When you can expect to return to work, sports, or other activities

 

Do you have more questions?

Q. What is an ORIF of a clavicle fracture?
A. ORIF stands for Open Reduction and Internal Fixation, a surgical procedure used to fix broken clavicle bones using plates and screws.

Q. When is surgery for a clavicle fracture necessary?
A. Surgery is necessary when the fractured bone fragments are significantly displaced, have not healed properly with non-operative treatment, or when there are multiple fractures.

Q. What are the common symptoms of a clavicle fracture?
A. Symptoms include pain, swelling, bruising, deformity, and difficulty moving the arm.

Q. What causes a clavicle fracture?
A. Clavicle fractures commonly result from falls, direct blows to the shoulder, or accidents such as car crashes or sports injuries.

Q. How is a clavicle fracture diagnosed?
A. It is diagnosed through physical examination and confirmed with imaging studies such as X-rays or CT scans.

Q. What does the surgical procedure involve?
A. The procedure involves making an incision over the fracture, aligning the bone fragments, and securing them with metal plates and screws.

Q. What type of anesthesia is used during ORIF of the clavicle?
A. The procedure is typically performed under general anesthesia.

Q. What is the recovery time after ORIF of a clavicle fracture?
A. Most patients can return to light activities within a few weeks, but full recovery and return to sports may take several months.

Q. What is the rehabilitation process like?
A. Rehabilitation involves physical therapy to restore motion, strength, and function to the shoulder.

Q. Are there risks associated with ORIF surgery?
A. Risks include infection, nerve or blood vessel damage, nonunion or malunion of the bone, and hardware irritation.

Q. Will I need to have the hardware removed later?
A. In some cases, if the hardware causes discomfort or other issues, it may be removed after the bone has healed.

Q. How effective is ORIF in treating clavicle fractures?
A. ORIF is generally effective and allows for reliable healing and restoration of shoulder function.

Q. Can I move my arm immediately after surgery?
A. Arm movement is usually limited immediately after surgery, and a sling is typically used to support the arm during early recovery.

Q. How long will I have to wear a sling after surgery?
A. A sling is usually worn for a few weeks depending on the extent of the fracture and the healing process.

Q. When can I return to sports after ORIF of a clavicle fracture?
A. Return to sports is typically allowed once the bone has healed completely and strength and range of motion are restored, usually in a few months.

Q. What follow-up care is required after surgery?
A. Follow-up visits include monitoring healing through physical exams and imaging and guiding rehabilitation.

Q. Can a clavicle fracture heal without surgery?
A. Some clavicle fractures can heal without surgery using conservative treatment like immobilization and physical therapy.

Q. How common are clavicle fractures?
A. Clavicle fractures are common, especially in young active individuals and athletes.

Q. Is there a high risk of re-fracture after healing?
A. The risk is low if the bone heals properly and patients follow post-operative guidelines.