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.

How Common It Is and Who Gets It? (Epidemiology)

Clavicle fractures are one of the most common bone fractures, especially in younger, active individuals. They often occur in athletes or individuals engaged in physically demanding activities. Clavicle fractures represent around 5% of all fractures in adults and are especially prevalent in those under 30 years of age. The injury typically occurs in the middle third (midshaft) of the clavicle, which is the weakest and most exposed part of the bone.

Why It Happens – Causes (Etiology and Pathophysiology)

Clavicle fractures are commonly caused by direct trauma to the shoulder, such as falling onto the shoulder, a direct blow, or road traffic accidents. These fractures are more common in athletes involved in contact sports (e.g., football, rugby, hockey) and in individuals involved in high-risk activities. The fracture occurs when significant force is applied to the clavicle, causing it to break or crack. In the case of a midshaft clavicle fracture, the bone may be displaced or misaligned, causing pain, dysfunction, and potential long-term complications if not treated properly.

How the Body Part Normally Works? (Relevant Anatomy)

The clavicle, or collarbone, serves as a strut between the sternum (breastbone) and the scapula (shoulder blade), helping to stabilize the shoulder and enable arm movement. It plays a critical role in supporting the shoulder girdle and providing attachment for muscles, including the pectoralis major, deltoid, and trapezius. The clavicle allows the arm to move freely and serves as a protective barrier for neurovascular structures passing from the neck to the arm. When fractured, the shoulder’s mobility and stability can be compromised, leading to difficulty with shoulder function and pain.

What You Might Feel – Symptoms (Clinical Presentation)

Patients with clavicle fractures typically experience sharp, localized pain in the shoulder area, often aggravated by any movement of the arm. Symptoms can include:

• Pain when lifting the arm or moving the shoulder
• Visible deformity or a bump at the fracture site
• Swelling, bruising, or tenderness over the clavicle
• Difficulty moving the arm or lifting objects
• A “grating” sensation when trying to move the shoulder

Severe fractures may cause difficulty in performing daily activities such as dressing, reaching overhead, or lifting objects.

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis of a clavicle fracture is based on physical examination, where the physician will assess for tenderness, swelling, and deformity at the clavicle. X-rays are typically used to confirm the diagnosis and determine the fracture type (displaced or non-displaced). If there are concerns about associated injuries or the need for surgical planning, a CT scan may be used to assess the severity and alignment of the fracture.

Classification

Clavicle fractures are commonly classified by location and severity:

• Midshaft fractures: The most common, occurring in the middle third of the clavicle.
• Lateral fractures: Involve the outer end of the clavicle, often associated with AC joint injuries.
• Medial fractures: Rare, occurring at the sternoclavicular joint.
  Fractures are also categorized by whether they are displaced (bone fragments are misaligned) or non-displaced (bones remain aligned).

Other Problems That Can Feel Similar (Differential Diagnosis)

Other conditions that may mimic the symptoms of clavicle fractures include acromioclavicular joint injuries, rotator cuff tears, shoulder dislocations, and rib fractures. Proper imaging and clinical evaluation are needed to distinguish between these conditions and determine the appropriate treatment.

Treatment Options

Non-Surgical Care

• Rest and immobilization with a sling for 3 to 6 weeks
• Ice and pain medication to control swelling and discomfort
• Physical therapy once the fracture has healed enough to restore shoulder mobility and strength

Surgical Care

• Open Reduction and Internal Fixation (ORIF): This surgical procedure is used when the fracture is displaced, involves multiple fragments, or is unlikely to heal properly with non-surgical treatment. It involves making an incision to realign the fractured bone and securing it with plates and screws.
• Clavicle plating: A metal plate is placed along the fractured clavicle, and screws are used to hold the bone in place.
• Pinning: In some cases, the fracture may be stabilized using pins, though this technique is less common today.

Recovery and What to Expect After Treatment

Recovery from clavicle fracture surgery generally involves:

• Wearing a sling to immobilize the arm and allow healing
• Gradual physical therapy starting around 2 weeks after surgery
• Strengthening exercises after 6 weeks
  Most patients can return to work within 1 to 2 months, with a full return to sports and physical activities typically occurring within 3 to 6 months.

Possible Risks or Side Effects (Complications)

Complications following ORIF of clavicle fractures may include:

• Infection
• Nonunion or malunion of the fracture (the bone does not heal properly)
• Hardware irritation or failure (plates or screws may need to be removed)
• Nerve damage (rare)
• Stiffness or weakness in the shoulder
  In general, these risks are relatively low and are minimized with careful surgical technique.

Long-Term Outlook (Prognosis)

The prognosis for patients undergoing ORIF for clavicle fractures is generally excellent, with most patients regaining full shoulder function and returning to normal activities. However, some may experience minor discomfort or stiffness, particularly if the fracture did not heal in perfect alignment. Long-term outcomes are favorable, with the majority of patients reporting good to excellent results, especially with appropriate rehabilitation.

Out-of-Pocket Costs for Treatment

Medicare

CPT Code 23515 – Open Reduction and Internal Fixation (ORIF) of Clavicle Fracture: $171.96

Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield usually cover that 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce patient financial responsibility.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans generally cover any remaining balance, including coinsurance or small deductibles, which typically range from $100 to $300, depending on your plan and provider network.

Workers’ Compensation

If your clavicle fracture and subsequent ORIF surgery are work-related, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your clavicle fracture and ORIF surgery are due to an automobile accident, No-Fault Insurance will typically cover the full cost of treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your insurance policy.

Example

John Williams required ORIF of a clavicle fracture (CPT 23515) after a cycling accident. His estimated Medicare out-of-pocket cost was $171.96. Since John had supplemental insurance through Blue Cross Blue Shield, his remaining balance was fully covered, leaving him with no out-of-pocket expenses for the surgery.

Frequently Asked Questions (FAQ)

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.

Summary and Takeaway

ORIF for clavicle fractures is a highly effective procedure for patients with displaced fractures or those at risk of malunion. By realigning and stabilizing the bone with plates and screws, this surgery ensures proper healing and minimizes the risk of long-term dysfunction. With appropriate post-surgery rehabilitation, most patients achieve excellent functional outcomes and return to normal activities.

Clinical Insight & Recent Findings

A recent systematic review compared the outcomes of latissimus dorsi tendon transfer (LDTT) and muscle advancement (MA) in the treatment of irreparable rotator cuff tears (IRCTs), particularly assessing pain relief, function, and complications. The study found that both techniques significantly improved shoulder function, with LDTT demonstrating superior external rotation outcomes and a lower retear rate (8.9% vs. 20.8%). However, the MA group experienced higher overall complications (25.7% vs. 18.0%) and failure rates, emphasizing the importance of selecting the appropriate surgical approach based on patient characteristics. LDTT was particularly effective in compensating for the lost rotator cuff function, while MA proved advantageous for joint stability but with higher long-term reoperation rates. This comparison highlights the need for tailored treatment strategies in managing IRCTs. (“Study on latissimus dorsi tendon transfer vs. muscle advancement – see PubMed.“)

Who Performs This Treatment? (Specialists and Team Involved)

Orthopedic surgeons specializing in fracture repair typically perform the ORIF procedure. Physical therapists assist in the postoperative rehabilitation process to restore shoulder function and strength.

When to See a Specialist?

Consult a specialist if you experience a shoulder injury that limits movement, causes significant pain, or shows signs of deformity, particularly after a fall or direct trauma.

When to Go to the Emergency Room?

Seek emergency care if you experience severe pain, swelling, or if the shoulder appears deformed following an injury. Immediate evaluation is necessary to assess for fractures or other associated injuries.

What Recovery Really Looks Like?

Recovery involves wearing a sling, followed by physical therapy to restore range of motion and strength. Full recovery, including overhead activity, may take several months, depending on the severity of the injury.

What Happens If You Ignore It?

If left untreated, clavicle fractures can result in chronic pain, weakness, and deformity, potentially leading to permanent shoulder dysfunction. Surgical intervention helps avoid these complications and restores shoulder function.

How to Prevent It?

Preventing clavicle fractures involves strengthening the shoulder muscles, using proper techniques during physical activities, and avoiding high-risk situations that can lead to falls or direct trauma.

Nutrition and Bone or Joint Health

A diet rich in calcium, vitamin D, and omega-3 fatty acids supports bone health and can aid in recovery after fracture surgery.

Activity and Lifestyle Modifications

Avoiding excessive overhead lifting or repetitive strain on the shoulder joint can help prevent future injuries and improve long-term shoulder health.