CONSEQUENCES OF IGNORING A COLLARBONE FRACTURE

by surgeon Mr Ian Bayley

A broken collarbone conservatively managed using the routinely prescribed collar and cuff or shoulder arm sling or a figure of eight splint is not a treatment and can only be described as benign neglect of the broken bone. They do nothing to elongate the bone to maintain original length or encourage union of the two ends.

In many cases the bone heals shortened or fails to unite, or mal unites (malunion where the bone rotates and heals at a bad angle) all resulting in shoulder instability further down the line.

Those scenarios are a frequent cause of a condition called Scapular Dyskinesis (or winging scapula or shoulder blade malfunction).

Shortening of as little as one millimetre can throw additional strain on the shoulder blade and other elements in the kinetic chain such as spine and pelvis and predispose the patient to future discomfort and even injury.

The relationship between muscles and bone framework is altered with devastating effect. Muscles contrive to work abnormally, shoulder blades can 'wing' unnaturally outward and shoulders fall forward; all adversely affecting pelvic and spinal alignment. Posture is weakened and, if left unchecked, cause the stronger muscles to reverse roles and deploy weaker sets. Chronic or intense pain ensues with a life left compromised by an altogether avoidable condition.

Our understanding of shoulder problems has increased in the forty years of my involvement in the field. We have come to understand the importance of the shoulder blade, how commonly it is compromised, and how resistant to surgery it can be. 

 So how do we tackle such an important and potentially life-changing condition?

Scapula dyskinesia comes in varying degrees and can often go undiagnosed. It is a debilitating but not untreatable condition and we need to be able to treat all degrees of severity, not just the critical cases that come into my clinic.

 One of the complications in treating the condition is the lack in the scapular (shoulder blade) of good mechanoreceptors - sensory receptors that rapidly transmit sensory information to the brain and the means by which the brain senses the position of shoulder joints/scapula.

 Patients simply don't know if their scapula is winging, added to which the brain readily accepts the abnormal movement as normal.

 For the vast majority of patients, physiotherapy is the first line of combat. In many cases, again for the majority, corrective exercise alone does not solve the problem. With surgery very much a last resort and no promise of success, patients are often left disappointed and in despair.

 We need new ways to tackle this condition. Having had first-hand experience of Angel Med’s new ClaviBrace Orthopaedic Gilet, I am very excited by its potential which I believe can hold the answer.

 For me it obeys the crucial principle of supporting the three pillars, or better stepping stones - namely the pelvis, spine and shoulder blades – upon which effective shoulder function ultimately depends and it delivers this in a way acceptable to the wearer.

 This is still a medical brace, but components are cleverly concealed in an everyday-looking gilet and since long-term wear may be necessary, it avoids any feeling of self-consciousness.

Mr Ian Bayley is a senior consultant orthopaedic surgeon with BMI Hospitals and has a busy clinical practice in shoulder surgery. 

He was appointed to open and direct the Spinal Injuries Unit at the Royal National Orthopaedic Hospital Stanmore in 1980 and to direct and develop the complex Shoulder Surgery Unit. 

He also took on the role of National Clinical Chair of the NHS Orthopaedic Services collaborative and various subsequent service redevelopment roles on the national stage.  His experience is therefore based firmly at “the coal face” of clinical practice and spans the whole medical spectrum from acute care through rehabilitation to community reintegration, combined with service redesign and delivery.

He is a member of the British Elbow & Shoulder Surgeons, British Orthopaedic Association and the European Shoulder & Elbow Society.

His clinical interest is in complex pain states, instability, rotator cuff pathology, primary and revision shoulder replacement.