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We are wondering if we made the right choice for our son who was hit by a hockey stick and broke his collar bone. The X-ray showed a clean break with a slight displacement. The choice was between surgery to line up the bones perfectly with a metal plate and screws to hold it in place or a sling and let it heal the way it is. They say at his age (he's 10 years old), the bone will grow around the break and he'll never know the difference. Is that really true?
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Most clavicle (collar bone) injuries in this age group are in the middle of the bone. If the two ends of the broken bone stay in place and don't move apart, a simple sling can be used to immobilize the area until healing occurs. This type of nonoperative care is especially effective in younger athletes (less than 12 years old) because of their good potential for rapid bone growth.
Before these athletes can jump back into action, the surgeon must see that the child can move the arm fully and has strength equal to the uninvolved arm. X-rays must show that the bones have been knit back together.
Surgery to pin the bones together usually results in a more normal union of the fracture and faster return to sports. The surgical option is often recommended for older athletes with a displaced clavicular fracture. This age group doesn't heal quite as quickly as the younger folks. They may need a longer period of time for rehab and recovery.
Nonunion (fracture doesn't heal) or malunion (heals with deformity) are more common in the nonoperative group. The slightly displaced fracture in your child is considered a displaced fracture with malunion. The body will form a large callus of bone around the broken area. This will form a noticeable bump along the top of the clavicle that will eventually get smaller as the bone remodels itself. It may not go away completely. But its presence will not alter movement of the clavicle or the biomechanics of the clavicle-shoulder complex.
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