Surgeon Mr Ian Bayley, assesses collarbone fractures, the consequences of ignoring them, treatment and outcomes

Mr Ian Bayley is a senior consultant orthopaedic surgeon with BMI Hospitals and has a busy Harley Street practice. His clinical interest is in complex pain states, instability, rotator cuff pathology, primary and revision shoulder replacement.

Until comparatively recently the conservative treatment of clavicle fractures was problematic and, in many cases totally unsatisfactory. Simple slings, such as most people leave the accident and emergency department with, have been shown to be ineffective and uncomfortable. 

They do not control pain or elongate a displaced and shortened fracture. Many sufferers therefore, are left in excruciating pain and with little chance of the broken bone re-aligning or achieving its original length.

Traditional figure-of-eight splints, often used in an attempt to reduce the fracture, invariably bear down on the broken bone, cut-in at the base of the neck and at the underarms with risk of local neurovascular compression.

Out of this consequence two schools of thought develop. On the one hand, there was (and is) the benign neglect approach that simply leaves the fracture to do what it may. On the other hand, invasive surgical reduction and internal fixation.

The downside of doing nothing is that it can lead to mal-union resulting in bony prominence at the fracture. This produces not only an unsightly knuckle of bone but (and often forgotten) also difficulty wearing straps such as for a rucksack or shoulder bag over that side. Furthermore, a poor union of the fracture also leads to mal-positioning of the shoulder blade and secondary disability, such as scapula dyskinesia.

On the other hand, the downsides of surgery are self-evident, including the dangers of infection and the failure of fixation: quite apart from the wrong-headed thinking of doing potentially unnecessary surgery.

So, what of using a relatively new treatment - the Clavibrace? developed by a collarbone fracture sufferer and championed by Prof Angus Wallace - and styled to look like an everyday gilet with all bracing components cleverly hidden within. The new style brace corrects and re-aligns the collarbone - in many cases avoiding the need for surgery - and just as important, it stops pain.

Mr Bayley explains, "I have used ClaviBrace? on my own clavicle fracture patients and in my view its development by Mrs Barbara Thompson and Professor Angus Wallace was a singular and important advance. For the first time it offers a proactive conservative option that is both effective and as good in its outcome as the surgical route. With this device, conservative treatment can be selected for positive reasons rather than by default." 

CONSEQUENCES OF IGNORING A CLAVICLE (Collarbone) FRACTURE by Mr Ian Bayley

A frequent cause of scapular dyskinesia or the shoulder blade protruding outwards (or known as winging scapula or shoulder blade malfunction) is a broken and displaced clavicle which, without intervention, can heal in a displaced shortened position.

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," says Mr Bayley. "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 even fall out of the health system altogether.

"We need new ways to tackle this condition," insists Mr Bayley. "Having had first-hand experience of Angel Med’s new ClaviBrace? Orthopaedic Gilet, I am very excited by its potential which I believe could 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".

So what is this ClaviBrace? Gilet?

It is essentially a medical brace, albeit styled as an everyday looking gilet. Bracing components have been concealed within and since long-term wear may be necessary, overcoming any feeling of self-consciousness. Specially developed anti-rash airflow fabrics avoid overheating and skin irritation. Integrated plastic stays, back and front, lift the diaphragm and support the spine. All components combining to hold the gilet in place, delivering shoulder and pelvis stability and good core muscle control.

All inquiries welcome, 01476 516200 / [email protected]

Mr Ian Bayley is a senior consultant orthopaedic surgeon with BMI Hospitals and has a busy Harley Street practice. His clinical interest is in complex pain states, instability, rotator cuff pathology, primary and revision shoulder replacement.

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.