From the Guidelines
I strongly recommend obtaining regular X-rays of the right clavicle after surgical reduction and stabilization to monitor healing progress and hardware stability, as suggested by the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1. The X-rays should include anteroposterior (AP) and lateral views, and should be performed at specific intervals:
- Initially at 2 weeks post-surgery to confirm proper alignment
- At 6 weeks to assess early healing
- At 3 months to evaluate bone union
- At 6 months to confirm complete healing and hardware stability. These regular X-rays are crucial to monitor bone callus formation, ensure the surgical reduction remains anatomically aligned, and verify that the hardware (plates, screws, or pins) remains properly positioned without signs of loosening or breakage, as emphasized in the guideline summary 1. Additional X-rays should be obtained immediately if the patient experiences new pain, decreased range of motion, or any concerns about hardware loosening or failure. Proper radiographic follow-up helps guide decisions about activity progression, physical therapy adjustments, and determines if and when hardware removal might be necessary, which is typically considered after complete healing (usually 9-12 months post-surgery) if the hardware causes discomfort or functional limitations, in line with the recommendations from the American Academy of Orthopaedic Surgeons 1.
From the Research
Recommended X-rays for Right Clavicle Fracture with Surgical Reduction and Stabilization
- X-rays are typically used to evaluate and follow up on clavicle fractures, including those that have undergone surgical reduction and stabilization 2
- The goals of imaging evaluation for clavicle fractures include identifying the fracture site and pattern, as well as determining the degree of displacement and comminution 3, 2
- Plain radiographs are commonly used to assess the fracture and monitor healing, with classification systems such as Allman's classification used to guide management decisions 3, 4
- For patients with displaced clavicle fractures, especially young and active individuals, operative treatment may be discussed, and x-rays can help determine the need for surgical intervention 5
- In cases where surgical reduction and stabilization have been performed, x-rays can be used to assess the adequacy of reduction and stability, as well as to monitor for potential complications such as nonunion or malunion 3, 4
Indications for X-rays
- Initial evaluation of clavicle fracture to determine fracture site and pattern
- Follow-up evaluation to monitor healing and assess adequacy of reduction and stability
- Evaluation of potential complications such as nonunion or malunion
- Assessment of fracture displacement, comminution, and shortening to guide management decisions 3, 5, 4, 2
Classification and Management
- Clavicle fractures can be classified into midshaft, lateral, and medial fractures, with different management approaches for each type 3, 5, 4
- Nondisplaced fractures are typically treated conservatively, while displaced fractures may require operative treatment, especially in young and active individuals 3, 5, 4
- X-rays can help guide management decisions by providing information on fracture characteristics and adequacy of reduction and stability 3, 5, 4, 2