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Our son broke his collar bone playing football over the weekend. The surgeon insisted on doing surgery. I thought collar bone fractures were always treated with a sling or one of those figure-eight collar bone devices. Is that old school now?

You didn't mention how old your son is but age, weight, and severity of the fracture can make a difference. Fractures may be treated differently in a young child who is still growing. Teens who have passed the fast growing stage but who aren't fully (skeletally) mature should not be treated the same as either children or adults. In the case of the collar bone (referred to as the clavicle in medical terms), this is one of the last bones to finish ossifying (hardening into bone). That's one reason why young children and teens who break their clavicle are often put in a sling or figure-eight collar -- the bone repairs, remodels, and is restored fairly easily. But if growth is complete (or nearly done) -- and this is seen on X-rays -- then the ability of the clavicle to remodel and repair is much more limited. In such cases, if the fracture is displaced (separated) then surgery may be required. Studies have shown that completely displaced clavicular fractures should be reduced (ends of the bones put back together) and held together with pins or metal plates and screws until healing takes place. With open reduction and internal fixation (ORIF), healing takes place much faster compared with nonoperative care. This is a boon for patients who participate in sports because they can return to play much sooner (three months after surgery rather than four months later).

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