Clavicle Fracture Fixation Protocol

Immediate Post-surgery

Waking up
Most patients feel dizzy and tired for a few hours after the surgery. You can simply sleep it off. Some patients may feel nausea and even experience some vomiting as well, but with modern anaesthesia, this is very much less common, and should not last more than 2-3 hours.

Pain from the surgery is tolerable. Most patients feel that the pain after surgery is less than that they were feeling before the surgery. The pain after surgery usually goes away after 3 – 4 days.

Wounds and dressings
There will be a bulky dressing over the shoulder which can be removed either on the same day (at night) or the next morning. You will find a waterproof dressing underneath the bulky dressing. You can take a shower, but please do not take baths or soak in water until the wounds are well healed.

Stitches used may or may not need removal after 12-14 days. This is on a case-by-case basis. But if required, this can be quickly and easily done at ours or any doctor’s office.

Going home and medications
Most patients go home from hospital either later on the same day of the surgery, or the next morning. You will be discharged with pain medications, which many patients may not even take!

But if you have pain, do not be worried about taking pain medications. The pain medications prescribed are simple, non-addictive ones which will not cause problems in the future. Antibiotics are not usually required, unless there are some concerns with regards to increased infection risks like a eczema over the skin, pimples around the area, previous tendency to get infections etc.

Arm sling
Most patients will wear a simple sling for 1 – 2 weeks. You may remove the sling and rest the arm at your side, as long as you do not try to externally rotate your arm beyond neutral (i.e wrist and hand pointing directly forwards, with your elbow flexed at 90°).

I generally do not strictly require patients to wear the arm slings all the time. I also allow patients to sleep without their arm slings, although patients and their parents/ spouses know themselves best. So if they are particularly “violent” sleepers, wearing the arm sling for the first couple of weeks when they sleep is certainly not a bad idea!

Try not to lift your arm beyond shoulder level for the first 2 weeks. This is to ensure that the wound heals up nicely. Excessive movements at the shoulder may cause tension in the wound. Although the wound is securely closed with stitches, excessive tension in the wound may result in a more unsightly scar.

Initial follow up schedule
For a typical patient, the timeline is usually:

• Return home either on same day of surgery or the next morning
• Review in clinic on post-operative day (POD) 5 for first dressing change (this is advised because the hot and humid weather in Singapore often makes the skin under the dressing irritated)
• Review in clinic on POD 12 – 14 for removal of stitches and dressing. A water-resistant spray will be applied so you can shower over the healed wound without needing anymore dressings.
• Physiotherapy can commence at any time. If patients have more discomfort in the surrounding muscles, they can often get some relief with physiotherapy. But if they would rather allow wounds to heal and give the shoulder some time to settle down before commencing physiotherapy, it is also reasonable. I usually start patients on physiotherapy about 2 weeks after the surgery.

Recovery Post-Surgery

All patients will have stiffness in their shoulder after surgery. This is temporary, although it may take 6 weeks to 3 months to regain full movements in the shoulder. The post-operative protocol below is meant as a guide and is deliberately concise so that patients will not be swamped with excessive details.

Week 0 – 1: (Goal: Pain control, healing of wounds)

• Arm sling is optional. Feel free to use one if you feel more comfortable with it.
• Move shoulder as tolerated but avoid lifting your arm beyond shoulder level.
• Ensure that you move the rest of the limb like the fingers, wrist and elbow.
• Do not attempt to lift any loads.

Week 1 – 6: (Goal: Regain passive and active range of movement)

• Begin working on both passive and active range of movement (ROM). Passive ROM refers to moving the shoulder with the help of your other arm, or movements done by someone else like a physiotherapist. Active ROM refers to moving the arm using the power of that same arm.
• If raising your arm beyond a certain level causes pain in the operation site, back off, let it rest a few days then restart gradually.
• Work on strength of the muscles around the shoulder eg the deltoid muscles and muscles around the scapular.
• Do not attempt to lift any loads.
• Jogging and running is fine. Please do not fall!

Week 6 – 12: (Goal: Commence strength training)

• Work on regaining full ROM in the shoulder.
• Commence progressive strength training of the shoulder including rotator cuff strength training.
• You may start to lift light loads but only within your comfort level.

Month 3 – 6: (Goal: Achieve full active ROM and start work on strength)

• Work on further increasing ROM (some patients will still have some restriction in ROM especially nearing their maximum range).
• Continue strength training of the shoulder.
• Commence functional training, specific to the patient’s sporting activities.
• Light non-contact sports that do not involve heavy loading of the shoulder is permissible but again, if there is pain, you are not ready yet.

Month 6 onwards: (Goal: Return to sport)

• Return to contact sports.
• Work with physiotherapist and sports trainer to address any gaps in the recovery.