Post-Operative Instructions:
Clavicle Fracture Fixation

Pain Medications

• In most cases local or regional nerve blocks will provide 8-12 hours of numbness.
  As soon as you start to feel the numbness wearing off, begin taking oral pain medication.

• Take Tylenol 500mg one tab every 8 hours.

• Take Aleve (Naproxen) 220mg two tabs (440mg total) every 12 hours with food.

• If you still have pain after Tylenol and Aleve/Naproxen, take one Norco tab (5mg/325mg).

• If you still have pain after all of the above, take a second Norco tab.

• Keep in mind Norco has Tylenol in it (325mg). If you take an extra Norco, then skip a dose of Tylenol.
  DO NOT exceed 3500mg of Tylenol over 24 hours. 

• It is illegal to drive or operate machinery with narcotic medications. 

• Do not combine alcohol or other sedatives with narcotic medications.

• You do not need to take pain medications once you no longer have pain.
  You should stop the Norco first (usually 2-3 days), then wean off the others over the next week or two.

Other Medications

• Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).

• Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.

Activity

• You may NOT bear any weight on or lift anything with your operative extremity.

• Elevate your operative extremity above the heart as much as possible to decrease swelling.

• It may be helpful to sleep on a recliner or with pillows supporting the arm.

Recovery Equipment

• You should wear the sling at all times day and night.

• You may remove the sling for hygiene. 

Cold Therapy

• We recommend cold therapy use as much as possible in the first two weeks. 

• Cold therapy units may be used continuously as instructed.

• Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.

• Do not apply ice directly to the skin to avoid burning.

Recovery Exercises

• You may perform elbow, wrist, and hand exercises as tolerated.

• You will begin physical therapy around two weeks after surgery, after your first postoperative visit.

Diet: Please refer to your preoperative packet instructions.

Incision Care: Please refer to your preoperative packet instructions.

Emergencies: Please refer to your preoperative packet instructions.

Post-Operative Rehabilitation: 
Clavicle Fracture Fixation

Therapy Plan: Twice per week for 0-3 months, once per week for 3-6 months

ROM Progression

Initial ROM weeks 2-6: 

• Shoulder motion - pendulums and gentle passive motion

• Elbow, wrist, hand passive and active motion as tolerated

Wean out of the sling over weeks 4-6 with the goal of being completely out of the sling at 6 weeks.

Progress passive and active ROM after 6 weeks as tolerated with the goal of full motion at 10-12 weeks.

Weight Bearing Progression

No strengthening for postoperative weeks 0-12 with progressive strengthening after week 12.

Initial Post-Operative Physical Therapy Visit (2 weeks)

• Instruct on ROM exercises as above

• Gentle passive motion, manual therapy

• Isometric exercises for core

Phase 1 Physical Therapy (2-6 weeks): protect the fixation, progress motion

• NO open-chain exercises

• Manual therapy 20+ minutes per session

• Gentle ROM as tolerated as above

• Soft tissue mobilization, isometric exercises, core strengthening

Phase 2 Physical Therapy (6-12 weeks): progressive motion

• Progress to full active ROM as tolerated as above

• Proprioceptive training

• Soft tissue mobilization, isometric exercises, core strengthening

Phase 3 Physical Therapy (12-18 weeks): progressive strengthening

• Progress to full ROM if not already obtained

• Initiate closed-chain and core strengthening

• Continue proprioceptive training

• Focus on functional exercises in all planes, advance only when fully controlled

Phase 4 Physical Therapy (18-24 weeks): return to pre-injury level and sport

• Advance closed-chain and core strengthening

• Sport-specific drills as tolerated

• Full return may take 4-6 months or more depending on surgery and recovery