eMedicine Specialties > Sports Medicine > Shoulder

Clavicular Injuries: Follow-up

Author: Kevin J Eerkes, MD, Clinical Assistant Professor, Department of Medicine, New York University School of Medicine; Medical team physician, New York University athletic teams
Coauthor(s): Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopaedic Surgery, Wishard hospital; John B Mitchell, MD, Consulting Staff, Department of Orthopedics, Kaiser Permanente
Contributor Information and Disclosures

Updated: Aug 18, 2008

Follow-up

Return to Play

Return to play depends on the location and severity of the clavicle fracture, the degree of clinical and radiographic healing, and the sport played.

Noncontact sports

Return to noncontact sports is allowed when (1) the clavicle fracture is healed (ie, no tenderness is present, and radiographs show callus formation), and (2) the patient has full, painless range of motion and has regained near-normal strength. These milestones have usually been reached at about 6 weeks from the time of the injury.

Contact sports

Return to contact sports takes much longer because the risk of refracture is high. The return to play should be delayed until the fracture union is solid, which can take from 2-6 months from the time of the injury or 4-6 weeks after after clinical and radiographic union. A donut pad or fiberglass shoulder shell may be used for extra protection.

Complications

Nonunion

Nonunion is a failure to show clinical or radiographic progression of healing after 4-6 months. The following are risk factors for nonunion: 

  •  Fracture comminution
  •  Significant fracture displacement or shortening
  •  Type 2 fractures of the distal third of the clavicle
  •  Refracture
  •  Female sex
  •  Advanced age
The nonunion rate for all midclavicle fractures treated nonoperatively is 6%. The nonunion rate for displaced midclavicle fractures treated nonoperatively is 15%. Note that many nonunions are asymptomatic, and no treatment is needed. Symptoms of nonunion can be pain, motion, or loss of function. Refer patients with symptomatic nonunion to an orthopedic surgeon to discuss surgical options. In some situations, a bone stimulator to help promote bone healing can be tried before surgery.

Malunion

Malunion is when the fracture heals with significant angulation, shortening, and a poor appearance. Mild malunion is common after clavicle fractures, but it is usually not clinically significant. Occasionally, the patient can have pain or a mild limitation of motion or strength. Symptoms from nerve impingement may occur but are uncommon. Surgeries for malunion attempt to restore the clavicular length and correct any angular deformity of the clavicle.

A spike of bone can form subcutaneously after angulated fractures heal. This can be symptomatic for athletes who wear shoulder pads or for backpackers. If a donut pad is not sufficient to relieve symptoms, surgical excision can be considered.

Other

Neurovascular compromise can develop from exuberant callus formation or from malunion. The medial cord and ulnar nerve are affected most often. Treatment is surgical in nature.

Posttraumatic arthritis can develop if the fracture enters the AC or SC joints.

Miscellaneous

Medicolegal Pitfalls

At the initial visit, discuss the following with the athlete who has a clavicular injury:

  • A visible prominence may remain at the fracture site after it heals. This may be more evident in thin individuals.
  • Fracture nonunion is possible, and surgery may be necessary.
  • Refracture is also a possibility when returning to contact sports, particularly if the athlete returns to play too soon.

Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Fracture
Resource Center Medical Malpractice and Legal Issues
Specialty Site Orthopaedics

 


More on Clavicular Injuries

Overview: Clavicular Injuries
Differential Diagnoses & Workup: Clavicular Injuries
Treatment & Medication: Clavicular Injuries
Follow-up: Clavicular Injuries
Multimedia: Clavicular Injuries
References
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References

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Further Reading

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Keywords

clavicular injuries, clavicle fracture, clavicle fractures, clavicle dislocation, shoulder injury, shoulder girdle injury, collar bone fractures, broken collar bone

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Contributor Information and Disclosures

Author

Kevin J Eerkes, MD, Clinical Assistant Professor, Department of Medicine, New York University School of Medicine; Medical team physician, New York University athletic teams
Disclosure: Nothing to disclose.

Coauthor(s)

Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopaedic Surgery, Wishard hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

John B Mitchell, MD, Consulting Staff, Department of Orthopedics, Kaiser Permanente
Disclosure: Nothing to disclose.

Medical Editor

Joseph P Garry, MD, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, North American Primary Care Research Group, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Henry T Goitz, MD, Chief, Sports Medicine, Associate Professor, Department of Orthopaedic Surgery, Medical College of Ohio
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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