When treated nonoperatively, a patient will often wear a shoulder immobilizer, sling or a figure-of-eight brace for comfort while the bone heals (Figure 1). It is difficult to reduce and maintain the reduction of clavicle fractures; in other words, it is difficult to hold the two ends of the broken bone together in perfect alignment. Despite this, healing usually proceeds rapidly.

It is very common for the patient to be left with a prominent bump where the fracture has healed due to the bony callus that is produced during the healing process. Almost all patients do well functionally despite this bump. It may be possible to prevent formation of the bump by fixing the bone surgically with a plate and screws. However, this simply trades one cosmetic deformity (the prominent bump) for another (a surgical scar), and it subjects the patient to the risks associated with the anesthesia that must be administered in order to to perform the procedure.

A physician is likely to recommend surgery (Figure 2) when:

• the fracture is open, meaning that the bone has been exposed to the outside world through a wound. Your surgeon will most likely wash out the wound in the operating room, and he or she may then repair the bone using hardware (usually a plate and screws) at that time, or possibly during a subsequent wash-out procedure.
• the sharp ends of the fractured bone cause tenting of the skin (in other words, the bone looks like it is going to pop through the skin).
• there is significant shortening of the bone due to overlapping of the two bone ends at the fracture site, which may cause medialization of the shoulder girdle.
• the clavicle does not heal on its own after several months (this is called a nonunion).
• the patient has multiple injuries to other parts of the body and needs to use the affected upper extremity during the rehabilitation period.
• the clavicle fracture occurs as part of a floating shoulder injury.