Clavicle surgery, most often performed as an open reduction internal fixation (ORIF) procedure, involves realigning the broken collarbone segments and securing them with specialized medical hardware, such as a plate and screws. This operation is typically necessary for severely displaced fractures or those with multiple fragments to restore the bone’s proper length and alignment. The recovery process requires dedicated care and adherence to specific protocols, demanding patience and a phased approach to rehabilitation. This guide outlines the different stages of healing and the expectations for each period.
Immediate Post-Operative Care and Pain Management
The first 48 to 72 hours following clavicle surgery focus on stabilizing the patient and managing acute discomfort. Upon waking, patients often experience drowsiness and some localized numbness, especially if a nerve block was administered during the procedure. The effects of the nerve block, which can provide several hours of initial pain relief, will gradually wear off, requiring a transition to oral pain medication.
A scheduled regimen of pain medication is important to keep discomfort controlled. Using non-pharmacological methods, such as applying ice or a cooling device to the shoulder, is highly effective in reducing both pain and swelling during this initial phase. The ice application should be frequent, typically 20 minutes on and 20 minutes off for the first few days, always using a protective barrier to prevent skin injury.
Initial wound care involves protecting the surgical incision, which is usually covered with a waterproof dressing that must be kept clean and dry according to the surgeon’s instructions. Swelling and bruising around the shoulder and sometimes down the arm are normal post-operative findings. Any sign of excessive fluid leakage or a foul odor from the incision site, however, must be immediately reported to the surgical team.
Navigating Early Recovery and Activity Restrictions
The early recovery period, generally spanning the first four to six weeks, is characterized by strict immobilization and protection of the surgical repair. A sling is worn continuously during this time to support the arm and prevent inadvertent movement that could compromise the plate and screws. It is important to wear the sling properly, only removing it for hygiene and prescribed gentle exercises for the elbow, wrist, and hand.
Daily activities require significant modification to protect the clavicle. Patients must adhere to a strict weight restriction, typically prohibiting the lifting of anything heavier than a very small object, such as a cup of coffee or a pencil, with the affected arm. During this immobilization phase, driving is prohibited, primarily due to the inability to react quickly or safely operate the steering wheel with the affected shoulder.
Sleeping can present a challenge, and many patients find comfort sleeping in a semi-reclined position, such as in a recliner chair or propped up with several pillows in bed. Maintaining hygiene requires careful planning; while showering is permitted, patients must avoid submerging the incision in baths, pools, or hot tubs until the wound is completely healed, which often takes about four to six weeks.
The Role of Physical Therapy and Long-Term Healing
Physical therapy (PT) marks the transition from passive protection to active recovery and is a core component of long-term healing. PT typically begins around four to six weeks post-operation, though some protocols may start with gentle mobilization as early as two weeks. The initial goals of rehabilitation are to restore passive and active range of motion to the shoulder, which can become stiff from the period of immobilization.
Early PT exercises focus on restoring flexibility, often starting with active-assisted motion where the unaffected arm or a therapist helps move the surgical arm. Once adequate motion is regained, the focus shifts to strengthening the muscles surrounding the shoulder, including the rotator cuff and periscapular muscles. The progression from light activity, such as desk work, to heavy manual labor or sports is gradual, often requiring three to six months, and is guided by radiographic evidence of bone healing.
The metal hardware—the plate and screws—is usually left in place permanently unless it causes irritation or discomfort, a condition known as symptomatic hardware. While bone healing can take three to five months, the return to full, unrestricted activity is contingent upon achieving full range of motion, normal strength, and complete bone union confirmed by imaging.
Recognizing Potential Complications and When to Contact Your Doctor
While clavicle surgery is generally successful, patients must remain vigilant for specific signs that may indicate a complication. The most immediate concern is a surgical site infection, which can be signaled by increasing redness, warmth, or swelling around the incision that worsens after the first few days. A persistent, high fever above 101.5 degrees Fahrenheit, severe chills, or a foul-smelling discharge from the wound are also clear indicators of a potential infection requiring urgent medical attention.
Nerve or vascular issues are less common but require immediate evaluation. These can manifest as new or worsening numbness, a tingling sensation in the hand or fingers, or the fingers becoming unusually cold or pale, suggesting pressure or injury to the nearby nerves or blood vessels.
Signs of implant failure or non-union, where the bone fails to heal, typically appear weeks or months after the surgery. A sudden onset of sharp, severe pain, a palpable new bump, or a visible change in the shape of the clavicle long after the initial post-operative period can indicate that the hardware has broken or the fracture site is unstable. In any of these scenarios—worsening pain not managed by medication, signs of infection, or new neurovascular symptoms—it is important to contact the surgeon’s office immediately or seek emergency care if the symptoms are severe or rapidly progressing.