Overview
Your clavicle (collarbone) is the strut that holds your shoulder out from your chest wall. Most clavicle fractures happen in the middle third of the bone after a direct fall onto the shoulder. Many heal well in a simple sling. But fractures that are badly shortened, shifted out of place, or shattered into multiple pieces are different. Treated without surgery, these have a higher rate of failing to heal (non-union) and a worse-working shoulder long-term.
Surgery is typically offered in a few situations. The bone is noticeably shortened. The pieces are widely out of place. A sharp piece is tenting the skin, or the fracture is open. It is also offered when an active patient wants the most reliable return to full strength.
Why it's done
We typically consider clavicle ORIF when imaging and the exam together show the fracture will not reliably heal or work without fixation. Common reasons include:
Pieces shifted well out of line
When the bone has shifted this far, the odds of healing without surgery fall sharply.
Noticeable shortening
A shortened collarbone changes how the shoulder and shoulder blade sit and move.
Skin tenting or open fracture
Skin at risk of breaking down means the bone needs to be set and fixed.
Floating shoulder or nerve/vessel injury
A "floating shoulder" means both the collarbone and another bone nearby are broken. That leaves the arm without any bony attachment to the chest, so both breaks almost always need fixing. A nerve or vessel injury alongside the fracture also calls for surgery.
Active patient with functional demands
Plating offers a more predictable return to overhead and throwing activity.
How it works
The incision runs along the top or front edge of the collarbone. The bone pieces are pulled back to their original length and rotation. A pre-shaped plate is laid on the bone and held with multiple screws on each side of the fracture.
When the bone is broken into several pieces (comminuted), the smaller pieces are typically held in place with small screws or stitches. Live X-ray in the operating room confirms that the alignment is restored and the screws are the correct length.
Recovery
The arm is kept in a sling during early recovery. Pendulum exercises (letting the arm hang and swing gently) and gentle passive motion start right away. Active motion progresses as pain allows. Full overhead use returns as healing permits. Healing of the bone (union) is confirmed on X-ray at follow-up visits. Irritation from the plate is not uncommon. Once the fracture is fully healed, the plate can be removed if it bothers you.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or schedule an appointment online.
Physicians Who Perform Clavicle ORIF
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb helps new bone form. Keeping all load off a fixed fracture for too long can actually slow healing and stiffen the joints above and below. Full body weight right away, however, can overload the repair before bone has caught up. The right answer sits in between. Your surgeon sets a step-by-step loading plan. It is based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on X-rays after surgery. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a shoulder that sits forward and down, a weak shrug, and a visible bump where the bone heals short and crooked. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss with you before clavicle ORIF include:
- bleeding and infection
- anesthesia risk
- hardware irritation (very common, many patients have the plate removed later)
- non-union
- irritation of a skin nerve (the supraclavicular nerve) causing numbness over the chest wall
- scar appearance
- blood clot (rare in upper-extremity surgery)
Surgery is appropriate when your collarbone fracture is out of place, shortened, or broken into multiple pieces (comminuted), and you will benefit from having it restored to its original alignment. If that picture does not fit you, this operation is not offered.
Frequently Asked
questions we hear in clinicDo all broken collarbones need surgery?
No. Most clavicle fractures happen in the middle third of the bone and many heal well in a simple sling. Surgery is typically offered when the bone is noticeably shortened, the pieces are widely out of place, a sharp piece is tenting the skin, the fracture is open, or an active patient wants the most reliable return to full strength.
What happens if a badly displaced fracture is treated without surgery?
Fractures that are badly shortened, shifted out of place, or shattered into multiple pieces have a higher rate of failing to heal (non-union) and a worse-working shoulder long-term. A collarbone that heals short and crooked can leave the shoulder sitting forward and down, a weak shrug, and a visible bump.
When can I move my arm after surgery?
The arm is kept in a sling during early recovery, but motion starts right away: pendulum exercises (letting the arm hang and swing gently) and gentle passive motion begin immediately. Active motion progresses as pain allows, and full overhead use returns as healing permits.
Does the plate come out later?
It can. Irritation from the plate is not uncommon, and many patients have the plate removed later. Once the fracture is fully healed, the plate can be removed if it bothers you.
How much can I use the arm while the bone heals?
Controlled load is part of how bone heals, so your surgeon sets a step-by-step loading plan based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on X-rays after surgery. We tell you exactly how much the limb can take, when to advance, and what to watch for.
What are the main risks?
The risks we discuss include bleeding and infection, anesthesia risk, hardware irritation (very common), non-union, numbness over the chest wall from irritation of a skin nerve, scar appearance, and rarely a blood clot. The full picture is in the Risks section above.
Further Reading
External patient-education references and related OSI pages for additional background: