Overview
The clavicle is the strut that holds the shoulder out from the chest wall. Most clavicle fractures occur in the middle third of the bone after a direct fall onto the shoulder. Many heal well in a sling, but fractures that are significantly shortened, displaced, or comminuted have a higher rate of nonunion and poor shoulder function when treated non-operatively.
Surgery is typically offered for shortening greater than about two centimeters, wide displacement, skin tenting, open injury, or certain fracture patterns in active patients who want the most reliable return to full strength.
Why it's done
Clavicle ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Displacement greater than one bone width
Non-operative healing rates fall sharply with this degree of displacement.
Significant shortening (>2 cm)
Shoulder mechanics and scapular position are altered.
Skin tenting or open fracture
At-risk skin requires reduction and fixation.
Floating shoulder or neurovascular injury
Associated injuries often demand stabilization.
Active patient with functional demands
Plating offers a more predictable return to overhead and throwing activity.
How it works
Through an incision along the top or front edge of the clavicle, the fracture is reduced to restore length and rotation. A pre-contoured plate is laid on the bone — either superior or anterior — and secured with multiple screws on each side of the fracture.
Comminuted fragments are typically held in place with small lag screws or sutures. Fluoroscopy confirms reduction and screw length.
Recovery
The arm is kept in a sling during early recovery, with pendulum and gentle passive motion starting right away. Active motion progresses as pain allows, with return to full overhead use as healing permits. Union is confirmed on X-ray at follow-up visits. Hardware irritation at the plate is not uncommon; elective hardware removal can be considered once the fracture is fully healed.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes a shoulder that sits forward and down, a weak shrug, and the visible bump and shortening of a mal-united clavicle. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before clavicle orif include:
- bleeding and infection
- anesthesia risk
- hardware irritation (very common — many patients have the plate removed later)
- non-union
- supraclavicular nerve irritation producing chest-wall numbness
- scar appearance
- blood clot (rare in upper-extremity surgery)
The indication to proceed is a displaced, shortened, or comminuted midshaft clavicle fracture in a patient who will benefit from anatomic alignment. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: