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The clavicle is the bone that maintains a solid separation between the sternum and the shoulder. Because of its horizontal orientation it is exposed to trauma and clavicle fractures are a well known injury of which almost everyone is aware of whether they have had a clavicle fracture or not. What is also well known about the clavicle fracture injury and recovery is that it is painful and prolonged.

Thus it would be logical to assume that the aesthetic procedure of clavicle reduction osteotomies for shoulder narrowing would be like having a clavicle fracture on each side. While that thought is certainly not appealing it is also a misconception from many aspects.

Elective clavicle osteotomies and traumatic clavicle fractures are quite different. First the zone of injury in a clavicle osteotomy is much more limited than in a fracture. In a discrete region at the inner third of the clavicle (which is an uncommon location for a fracture) a fine line bone cut is made one each side of the bone removal site. In contrast clavicle fractures involve a much larger area of bone injury, usually in the outer two-thirds of the bone, and is never a clean fine line bone break. Fractures are often comminuted and have multiple breaks of the bone along its length. There is also much more soft tissue trauma with fractures,  usually involving the shoulder, which osteotomies do not have. 

Secondly clavicle osteotomies are always well stabilized by plate and screw fixation, providing limited motion across the osteotomy site. Many clavicle fractures may undergo non-surgical treatment using a sling which does not completely eliminate motion across the fractured bones…thus creating more discomfort during healing.

Third, clavicle osteotomies have good cross-sectional bone contact leading to a quick healing period. The bony apposition in clavicle fractures is less solid and more unstable, leading to a longer healing period.

On almost all comparisons a clavicle osteotomy is different from a clavicle fracture with less discomfort and a more rapid return to full arm range of motion and shoulder function. But there is one caveat…clavicle osteotomies are bilateral while clavicle fractures are one sided. That poses some interesting short term recovery issues which are not all that different from a clavicle fracture from a functional limitation standpoint.

Dr. Barry Eppley

Indianapolis, Indiana

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