Operation of a clavicula fracture
In most cases a clavicula fracture is treated non-surgically, i.e. conservatively. In newborns who have suffered a fracture as a result of a birth trauma, the fracture heals completely independently, so that no intervention is necessary. For older children and adults, dressing therapy, typically with a so-called rucksack bandage, is the rule.
The Gilchrist bandage, in which an arm sling is used, is also frequently used. Surgery is only considered if the fracture ends are not in the correct position. This is particularly often necessary for fractures in the area of the outer (lateral) clavicle, as these are the most unstable and a bandage is often not sufficient for stabilisation.
The operation then combines an open reduction, which means that after an incision in the skin, the ends of the fracture are brought back into the correct position, and fixation with an implant, usually a This is called osteosynthesis. A so-called intramedullary nail osteosynthesis, in which a nail is inserted into the collarbone, has also become more and more established in recent years. The advantage of this variant is that only small skin incisions are necessary.
In any case, surgery must be performed at:
- Are strongly angled or
- Clearly overlap, i.e. lie in a pronounced malposition. – plate or with
- Wires. – Accompanying injuries to vessels and nerves,
- For open fractures (i.e. those where the fracture ends have pierced the skin),
- For fractures near joints and
- For fractures with additional dislocation.
There are clearly defined reasons when affected persons need surgical treatment of a clavicula fracture. In medicine, we also speak of absolute indications. One of these is an open clavicula fracture, i.e. when a bone part has pierced the thin skin above.
Also the existing danger of a piercing afterwards makes an operation necessary. A dislocated fracture can also only be treated surgically. Displaced describes the condition of the bone fragments that have formed.
If these are displaced or twisted against each other, this is called dislocation. Due to this position, the bone ends can no longer grow together correctly, so that the original physiological form and functionality could be restored. As soon as surrounding structures such as nerves, ligaments or vessels are injured in the clavicula fracture, they must be treated in a surgical procedure in addition to the fracture itself.
Surgery may also still be necessary if conservative therapy measures already taken remain unsuccessful after 3 to 4 weeks. In addition, healing disorders of any kind are considered a reason for surgery. Nowadays it is known that surgical measures can achieve better results in terms of functionality than conservative therapeutic approaches.
Therefore, apart from the absolute indication criteria, an operation makes sense if affected persons have to put full weight on the shoulder and arm again for professional or sports reasons and are therefore dependent on a complete restoration of functionality. If a clavicula fracture has been treated with a plate, a later metal removal is usually planned. However, the plate is not removed until the clavicle has had enough time to grow back together.
The date for metal removal should therefore not be set too early. However, a later date is not optimal either, as the surrounding tissue may have formed too much around the plate, making removal more difficult. In case of a clavicula fracture, the plate is removed after about 18 months.
In children, removal may be indicated earlier. This is all done in a small surgical procedure under general anesthesia, which only takes about 45 minutes. The incision is made as in the first operation, so that there is no second scar.
