Commonly with non-displaced fractures conservative treatment is an option whereby you will immobilise the shoulder with the use of a sling and time is given for the bone to heal itself. Bone healing can take anywhere from 6 to 12 weeks depending on the patient.
If the injury was not severe, there is fairly rapid improvement and return of function after the first 4 to 6 weeks.
With proximal humerus fractures a sling would normally be worn for 2 to 3 weeks and then a course of physiotherapy can start in regards to working on the range of movement and function of the shoulder. Adequate pain relief will be required during this time to avoid any long-term stiffness of the joint.
Surgery may be indicated with proximal humeral fractures if the fracture was displaced or open, if there are other soft tissue structures involved or if there are injuries to the surrounding blood vessels of nerves.
During surgery pins and plates may be used to reconstruct the fracture site. Under severe conditions it may be of benefit to replace the humeral head or complete a full shoulder replacement.
Again, with clavicle fractures depending on the degree of the fracture they can be managed conservatively or surgically. Some surgeons would recommend people towards surgery as there was a big study from Canada that suggested that people who had had their clavicles fixed did much better than those who didn't and that study has just been repeated and published.
A more recent study was a much bigger study of 300 patients in London, randomised between having an operation and not having an operation. At the follow ups for up to 9 months, the people who had operations did better, so they recovered and got to go back to work quicker. They also got back to sport, quicker, had less pain and they had better cosmetics.
In regards to the surgery there are lots of ways, but a common way is to use a plating system, that's an American plating system. All the plates are already contoured to, with a variety of different shapes, so the surgeon can get the exactly right shape and size to fit you and your particular fracture.
It's done as day surgery so you come into hospital for the procedure, which is done under general anaesthetic, and then discharged on the same day. You will normally have a horizontal scar, the upper chest patch, it's a D shaped patch, which will be a bit numb, but then that heals itself in a couple of months.
In regards to risk to the procedure there's a small risk that the fracture won't heal despite having put a plate and put all the bits back together again. However, with modern plating systems and a good surgical technique, that's quite a low risk. And there's, of course, a scar, which you wouldn't have if you didn't have an operation and you would develop a numb patch on the chest side of the skin, just below the scar. As well as this there are all the normal risks associated with surgery such as infections and any risks of anaesthetic.
For scapular fractures surgery may be indicated if the fracture has caused a deformity to the joint by the angle that it is in, it has been displaced or the glenoid (where the head of the humerus site) has been fractured and therefore is causing instability to the shoulder joint.
If surgery is not indicated then the same process of immobilisation with a sling, ice, pain relief and then physiotherapy will be carried out.