Shoulder Fracture Surgery

What is it?

Clavicle

The operation is through an 8-12cm incision which goes from the front to the back of the shoulder. The fracture is reduced by putting the bone ends back together. They are held in place by an 8cm plate and some screws. The skin is then closed over with a dissolving stitch.

If the surgery is to treat a non-union (hasn’t healed), a bone graft may be taken from the hip. The bone in the iliac crest contains lots of bone healing cells and when placed at the fracture site, the graft helps the non-union to heal. Only a 1cm piece of bone is removed from the hip; however the operation site can be being very painful for a few weeks.

Humerus

Fractures which are badly displaced or have broken into the joint surface may require reconstruction. The decision to operate will depend on the way the bone has broken, the quality of the bone, the needs of the patient and the expertise of the surgeon. The most common operation for this type of fracture is the locking plate. Through a 10-15cm incision, the bone pieces are put back together and held with a plate and some screws. This is special plate which locks the screws in place and has revolutionised the treatment of osteoporotic fractures.

If the shoulder fragments are too badly broken, a joint replacement is an alternative option. This may be necessary when the screws cannot hold the broken pieces together because they are too small, the bone has been crushed, or the articular surface of the humeral head is split.

In some patients the tendons of the rotator cuff can be damaged. If this is the case, a reverse geometry shoulder replacement can restore excellent function in what would otherwise be painful shoulder with very restricted motion.

What should I expect during recovery?

Clavicle

The anaesthetist will have used an anaesthetic block to numb the arm during surgery and the immediate post-operative period. Once the anaesthetic has worn off after approximately 4-8 hours, the shoulder will become painful and you will be given regular pain relief. Even though you may be pain free at rest, you must take the pain relief regularly for when you move the shoulder as part of your rehabilitation program. A combination of paracetamol or codeine should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, unless contraindicated. If the pain killers you have been given are not sufficient, please contact your consultant’s secretary or your GP.

The procedure is an open operation through an 8-12cm incision and is closed with a dissolving stitch. This heals well, usually leaving a faint scar. The dressing should remain in place for 10-14 days. It should be kept clean and dry until it is removed at your follow up appointment. If you have any concerns about the wound you should contact your surgeon’s secretary or your GP practice nurse.

You will be given a sling to protect your shoulder and should be worn for a minimum of 3 weeks. You will also need a dedicated physiotherapy program after your surgery. If you have been seeing a physiotherapist prior to your surgery, you should arrange to see them afterwards so you can start your rehabilitation straight away. If you do not have a physiotherapist we can arrange a referral for you.

After surgery, full union is seen on X-ray typically at 12 weeks for adult patients, and shorter times are achieved in children. In patients who work hard with physiotherapy, 85-100% mobility returns in 6-9 months, with full strength returning in 9-12 months. You can return to driving and office work after 3 weeks, and manual work after 12 weeks.

What are the risks?

Operations to fix the clavicle are very successful and most people who have them are delighted with the operation and its results. As with any operation, there is a small amount of risk. The main risk is non-union and failure of the plate and screws. If the bone does not heal, the screws will pull out of the bone because they tire with repetitive movement. Some patients experience a patch of numb skin below the operation site which can be uncomfortable. Nerves can occasionally become bruised and the shoulder can become stiff.

The plate is occasionally visible under the skin and can cause irritation when wearing a seat belt or rucksack. The plate can be removed at 1 year but this is not routinely recommended. These risks account for only 3-5% of all operations, but should be taken into consideration when discussing treatment options with your surgeon.

Humerus

Both plating and joint replacement are carried out through a 10-15cm incision which is closed with a dissolving stitch. This heals well, usually leaving a faint scar. The dressing should remain on for 10-14 days. It should be kept clean and dry until it is removed at your follow up appointment. If you have any concerns about the wound you should contact your surgeon’s secretary or your GP practice nurse.

You will be given a sling to protect your shoulder and should be worn for a minimum of 3 weeks. You will also need a dedicated physiotherapy program after your surgery. If you have been seeing a physiotherapist prior to your surgery, you should arrange to see them afterwards so you can start your rehabilitation straight away. If you do not have a physiotherapist we can arrange a referral for you.