Clavicle ORIF Rehabilitation.
What is clavicle ORIF?
Clavicle open reduction and internal fixation (ORIF) is a surgical procedure to repair a fractured clavicle — the collarbone — by repositioning the fracture fragments into correct alignment and securing them with metal hardware, typically a plate and screws along the superior surface of the bone. It is performed when the fracture is significantly displaced, shortened or comminuted (multi-fragment) to a degree that carries unacceptable risk of malunion — healing in a poor position — with conservative management alone.
Clavicle fractures are among the most common fractures in young active adults, accounting for approximately five percent of all fractures and a disproportionate number of sporting injuries — cycling falls, contact sport collisions, and falls onto an outstretched arm are the most frequent mechanisms. The middle third of the clavicle is fractured in approximately 80% of cases.
Not all clavicle fractures require surgery. Minimally displaced fractures — even those with some overlap and shortening — can heal well in a sling with appropriate physiotherapy management. The surgical decision is based on the degree of displacement, shortening, soft tissue compromise, and the patient's activity demands and occupation. Cyclists, contact sport athletes and overhead workers with significantly displaced fractures are more frequently offered surgery given the functional demands on the shoulder.
Why is physiotherapy essential after clavicle ORIF?
The surgery stabilises the fracture — but it cannot rebuild the muscular and neuromuscular function of the shoulder that has been disrupted by the fracture, the surgical approach, and the period of sling immobilisation. Physiotherapy is crucial for restoring shoulder function through gradual exercises that improve range of motion and shoulder mechanics, rebuilding strength in the muscles supporting the clavicle and shoulder, and preventing complications including stiffness, weakness and improper movement patterns.
The clavicle plays a critical biomechanical role in shoulder function — it is the only bony connection between the arm and the axial skeleton, and it acts as a strut that maintains the correct position of the shoulder girdle relative to the thorax. Following fracture and surgical repair, the entire shoulder movement pattern is disrupted — the acromioclavicular joint, sternoclavicular joint, scapulothoracic rhythm and
What does rehabilitation involve?
In the first six weeks, the focus is on pain management, sling use, and gentle mobility exercises. From six to twelve weeks, gradual strengthening of the shoulder and arm muscles begins. From three to six months, functional movements and return to daily activities and light sport training are introduced. Full recovery and return to high-impact activities and contact sport at six to twelve months following clearance from your surgeon.
In the first four to six weeks while the sling is worn, physiotherapy introduces pendulum exercises for gentle glenohumeral movement, active hand, wrist and elbow exercises to prevent stiffness spreading beyond the shoulder, and scapular awareness work. Postural education is particularly important — the forward-rounded posture that develops rapidly with arm immobilisation increases load on the healing clavicle and must be actively countered.
From six to twelve weeks, as the fracture consolidates on X-ray and sling use is discontinued, active shoulder range-of-motion is progressively restored. Rotator cuff strengthening begins carefully — initially below shoulder height and away from positions that stress the healing plate — and scapular stabiliser strengthening becomes increasingly prominent. The lower trapezius, serratus anterior and middle trapezius are the priority muscles for restoring the scapular control that underlies normal shoulder mechanics.
From three to six months, strengthening progresses through full functional ranges and sport-specific rehabilitation is introduced. For overhead athletes, throwers and contact sport players, the rehabilitation must specifically prepare the shoulder for the demands of their sport — generic strengthening is insufficient for a returning cyclist or rugby player.
Clinical Pilates integrates well into the mid and later rehabilitation phases, providing controlled shoulder and scapular strengthening with precise load progression. Real time ultrasound assists in retraining deep rotator cuff and lower trapezius activation where inhibition from pain and surgery has disrupted normal muscle recruitment patterns.
One additional consideration: many clavicle plates are removed in a second surgical procedure six to twelve months after fixation once the bone has healed. If plate removal is planned, physiotherapy before and after removal ensures the best possible functional outcome from both procedures.
For patients whose clavicle fracture occurred in a motor vehicle accident or workplace incident, CTP and WorkCover funded rehabilitation is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in post-surgical shoulder and upper limb rehabilitation and are members of the Australian Physiotherapy Association. Exercise Physiologist Ash O'Regan contributes to sport-specific conditioning programs for athletes returning to contact and overhead sport.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Clavicle open reduction and internal fixation (ORIF) is a surgical procedure to repair a fractured clavicle — the collarbone — by repositioning the fracture fragments into correct alignment and securing them with metal hardware, typically a plate and screws along the superior surface of the bone. It is performed when the fracture is significantly displaced, shortened or comminuted (multi-fragment) to a degree that carries unacceptable risk of malunion — healing in a poor position — with conservative management alone.
Clavicle fractures are among the most common fractures in young active adults, accounting for approximately five percent of all fractures and a disproportionate number of sporting injuries — cycling falls, contact sport collisions, and falls onto an outstretched arm are the most frequent mechanisms. The middle third of the clavicle is fractured in approximately 80% of cases.
Not all clavicle fractures require surgery. Minimally displaced fractures — even those with some overlap and shortening — can heal well in a sling with appropriate physiotherapy management. The surgical decision is based on the degree of displacement, shortening, soft tissue compromise, and the patient's activity demands and occupation. Cyclists, contact sport athletes and overhead workers with significantly displaced fractures are more frequently offered surgery given the functional demands on the shoulder.
Why is physiotherapy essential after clavicle ORIF?
The surgery stabilises the fracture — but it cannot rebuild the muscular and neuromuscular function of the shoulder that has been disrupted by the fracture, the surgical approach, and the period of sling immobilisation. Physiotherapy is crucial for restoring shoulder function through gradual exercises that improve range of motion and shoulder mechanics, rebuilding strength in the muscles supporting the clavicle and shoulder, and preventing complications including stiffness, weakness and improper movement patterns.
The clavicle plays a critical biomechanical role in shoulder function — it is the only bony connection between the arm and the axial skeleton, and it acts as a strut that maintains the correct position of the shoulder girdle relative to the thorax. Following fracture and surgical repair, the entire shoulder movement pattern is disrupted — the acromioclavicular joint, sternoclavicular joint, scapulothoracic rhythm and
What does rehabilitation involve?
In the first six weeks, the focus is on pain management, sling use, and gentle mobility exercises. From six to twelve weeks, gradual strengthening of the shoulder and arm muscles begins. From three to six months, functional movements and return to daily activities and light sport training are introduced. Full recovery and return to high-impact activities and contact sport at six to twelve months following clearance from your surgeon.
In the first four to six weeks while the sling is worn, physiotherapy introduces pendulum exercises for gentle glenohumeral movement, active hand, wrist and elbow exercises to prevent stiffness spreading beyond the shoulder, and scapular awareness work. Postural education is particularly important — the forward-rounded posture that develops rapidly with arm immobilisation increases load on the healing clavicle and must be actively countered.
From six to twelve weeks, as the fracture consolidates on X-ray and sling use is discontinued, active shoulder range-of-motion is progressively restored. Rotator cuff strengthening begins carefully — initially below shoulder height and away from positions that stress the healing plate — and scapular stabiliser strengthening becomes increasingly prominent. The lower trapezius, serratus anterior and middle trapezius are the priority muscles for restoring the scapular control that underlies normal shoulder mechanics.
From three to six months, strengthening progresses through full functional ranges and sport-specific rehabilitation is introduced. For overhead athletes, throwers and contact sport players, the rehabilitation must specifically prepare the shoulder for the demands of their sport — generic strengthening is insufficient for a returning cyclist or rugby player.
Clinical Pilates integrates well into the mid and later rehabilitation phases, providing controlled shoulder and scapular strengthening with precise load progression. Real time ultrasound assists in retraining deep rotator cuff and lower trapezius activation where inhibition from pain and surgery has disrupted normal muscle recruitment patterns.
One additional consideration: many clavicle plates are removed in a second surgical procedure six to twelve months after fixation once the bone has healed. If plate removal is planned, physiotherapy before and after removal ensures the best possible functional outcome from both procedures.
For patients whose clavicle fracture occurred in a motor vehicle accident or workplace incident, CTP and WorkCover funded rehabilitation is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in post-surgical shoulder and upper limb rehabilitation and are members of the Australian Physiotherapy Association. Exercise Physiologist Ash O'Regan contributes to sport-specific conditioning programs for athletes returning to contact and overhead sport.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
