Clavicle Fracture Fixation

Arthroscopic Acromio-Clavicular (ACJ) excision is a common procedure undertaken to address the symtoms of shoulder pain. Its most commonly performed along with subacromial decompression of the shoulder.

The aim of the operation is to undertake a thorough examination of the shoulder joint and the subacromial space. A fibre-optic scope and small, pencil-sized instruments are inserted through small incisions instead of a large incision. The arthroscope is connected to a television monitor and the surgeon removes excess bone (spur) and shaves away the ends of the clavicle bone and acromion to provide an increased space so that the bones do not rub against each other.

At the end of surgery, the wound is closed with dissolvable sutures under the skin. Butterfly stitches, splash proof dressing and a pad is applied, and the arm rested in a sling.

Questions that are often asked

Is the surgery necessary?

This will be discussed with the patient at the time of the consultation..

Before Admission:

No food for 6 hours, or drink for 2 hours, prior to surgery.
Please avoid smoking for 12 hours prior to surgery.
Please continue to take all your medication as advised by the preassessment team.

What happens on the day of surgery?

You will need to report to the main reception on arrival. You will be shown to your room where you will be checked in by the nurse and also see Prof. Singh and the anaesthetist. This will give you chance to ask any questions before surgery. You will also be given an approximate time of your procedure. Please read the instructions on ‘Preparing for Surgery’.

What are the possible complications?

Scar: You will have a 12 – 15 cms incision over the clavicle. This area can be firm to touch & tender for 2 – 3 months. This can be helped by massaging the area with moisturizing cream once the wound has healed.
Infection: Can occur after any operation. This would be treated with antibiotics. This is uncommon following surgery for tennis elbow
Nerve Damage:It is common to have some numbness below the clavicle immediately after surgery, but this usually resolved over 6 months, sometimes this may be permanent, but is usually not disabling.
Bleeding: Can cause a collection of blood under the stitches which can cause wound problems. Tell the surgeon if you are on anticoagulants or aspirin
CRPS / Stiffness: About 5% (1 in 20) of people are sensitive to surgery and their hand and whole arm may become swollen, painful and stiff after any operation. This problem cannot be predicted but will be watched for afterwards and treated with therapy.
Failure:Sometimes the fixation can fail, or the plate fails and then patients can have recurrence of the problem. Commonly the ligament becomes a bit lax and a complete displacement is uncommon.

What kind of anaesthesia is used?

A combination of general anesthesia and a nerve block is used for most surgeries. Before the surgery, the anaesthetist will inject numbing medicine around the nerves of the shoulder. This numbs the arm and helps to control your pain after surgery.

How long will I be in the hospital?

The surgery is done as a day case and you should home within a few hours.

After hospital care:

Sling: After your surgery, you will be fitted with a high arm sling, which is to be used for 2 – 4weeks.
Medication: The nerve block usually lasts between 18 – 24 hours. Patients are encouraged to start taking painkillers before the pain starts i.e. on return home and for at least 48 hours.
Wound care &Removal of stitches: At the end of the surgery you have dissolvable sutures to close the skin which are tied over the skin. The sutures will need to be removed at 14 days after surgery which can be performed at your GP practice or nurse at the hospital.
Follow-up orthopaedic clinic: You will need to be reviewed in clinic after your operation. This is usually 2 – 4 weeks after surgery.
Physical Therapy A physiotherapist will assess you at the time of your operation and will give you exercises to do before you go home. You will be referred to physiotherapy either in the community or an outpatient department. Rehabilitation typically takes 4 to 6 months and in some cases, may take up to a year.
Return to Work: Managerial or Supervisory: 2– 3 weeks, Light Manual: 4 – 6 weeks (e.g. clerical, secretarial), Heavy Manual: 12 – 16 weeks (ground worker, HGV). Please discuss with your consultant / therapist if you have any queries.
Drivingyou may be able to drive once the pain is under control and you have movements in the arm – usually around 4 to 6 weeks after surgery. Please let your Motor Insurance Company aware of your procedure.