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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

Pain Management

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When I was a kid, I broke my collar bone falling forward over the handle bars of my bike. They put me in a sling for a month and I was fine. My grandson did the same thing and now it's an emergency surgery. Don't they use the sling anymore?

After 40 years of treating fractures of the collar bone (clavicle) with a sling or harness, there's evidence that a different treatment approach works better. Surgery may be needed, especially when the fracture is displaced. With a displaced fracture of the midshaft, the two ends of the bone are separated and no longer line up properly. The result can be malunion, continued pain, and loss of function. Comparing patients over time who were treated conservatively with a sling versus those who had surgery to repair the fracture, they found malunion was a major problem in the conservative care group. With a malunion, the fracture heals but the bone isn't lined up properly. As many as 25 per cent never achieved healing and developed additional problems such as injury to the nerves and blood vessels, refracture, and arthritis. Injury to the nerves and blood vessels caused paralysis and loss of motor function (nerve damage) and blood pooling in the tissues (blood vessel injury). Patients were not satisfied with the results of nonoperative treatment. When is surgery indicated? When there is 100 per cent displacement along the middle of the clavicle. That means the two ends of the bone are so far apart vertically (up and down direction) that even if the ends were brought back together, they wouldn't meet or touch. In some cases, the two ends of the bone overlap (one on top of the other). Severe shortening caused by this type of displacement requires surgery to restore the natural length of the bone needed for normal shoulder function. Most likely if an emergency surgery was required, there were complications, perhaps with bleeding or nerve injury. If there was time, the surgeon probably explained this to the parents or family members present at the time of the procedure. Sometimes the explanations don't come until after the emergency surgery has been done. When the time is right, don't hesitate to ask!


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