For a shoulder narrowing effect shortening of the length of the clavicle is needed. This is done by removing a segment of the clavicle bone which, when put back together, pulls the shoulder inward. Because the bone is cut and plates and screws applied to enable the bone to heal across the cut line, it initially appears that this would be very similar to the repair of a clavicle fracture. On the surface they seem similar but the reality is there are many ways in which the two are quite dissimilar from surgical technique to the recovery.
The biggest conceptual difference between clavicle fracture repair and shoulder narrowing is that the former attempts to re-establish the original length of the fractured bone while the latter makes a deliberate effort to shorten it. That is more than just a semantic difference, it poses major differences between the two clavicle operations.
In the effort to repair a clavicle fracture the orthopedic surgeon usually employs a long skin incision with a corresponding long fixation plate. The length of the fixation plate closely parallels the overlying length of the skin incision through which it is applied. Surgical access and the amount of hardware used are secondary to whatever it takes in this clavicle reconstruction procedure.
Conversely in shoulder reduction surgery the skin incision is much shorter in length and is placed as inconspicuously as possible in the supraclavicular fossa. As a result the length of the fixation plates used are much shorter as the access to apply them is less. (even though the loading stress on the bone healing site is really no different and may even be greater due to the lack of any injury to the shoulder soft tissues)
These differences are subsequently reflected in the recovery process. In clavicle fracture repair due to the trauma to the surrounding soft tissue due to how the bone was fractured, the goal is early physical therapy to keep the soft tissues from scarring and developing adhesions and limitation of arm range of motion. This is enabled because of the length of the hardware applied. Recovery from shoulder narrowing surgery is exactly the opposite. Arm range of motion is restricted as the hardware used is limited and the shoulder tissues are not injured. This a gradual increase in arm range of motion occurs upon to six weeks after the surgery. There is no long term risk of loss of arm range of motion as the osteotomy site is on the opposite end away from the shoulder joint.
In short the only similarity between repairing a clavicle fracture and shortening clavicular length is that both are done on the same bone. But the objectives, surgical technique and the recovery process are very different…even if they do share the common goal of what constitutes a successful outcome…a solid bony union.
Dr. Barry Eppley
World-Renowned Plastic Surgeon