What is the treatment for a displaced distal clavicle (collarbone) fracture?

From the Guidelines

Surgical intervention is the recommended treatment for displaced distal clavicle fractures due to the high risk of nonunion and malunion with conservative management. The American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1 supports this approach, citing increasing evidence that nonsurgical management of widely displaced fractures often results in malunions, which may have adverse effects on strength and function of the shoulder.

Key considerations for surgical treatment include:

• The type of surgical management used for fixation of clavicle fractures, with described techniques including plate osteosynthesis, intramedullary fixation, and coracoclavicular stabilization with suture buttons or screws 1
• The timing of surgery, which is generally performed within 1-2 weeks of injury for optimal outcomes
• Postoperative care, which typically involves wearing a sling for 2-4 weeks, followed by progressive range of motion exercises and strengthening exercises

The benefits of surgical treatment for displaced distal clavicle fractures include:

• Equivalent or improved short-term patient-reported outcomes compared to nonsurgical treatment 1
• Reduced rates of nonunion or symptomatic malunion 1
• Faster functional and radiographic recovery, allowing for earlier return to work 1
• Decreased recovery time, leading to a more rapid return to work, decreasing lost wages, and lower need for physical therapy compared to nonsurgical treatment 1

Overall, the current evidence supports surgical intervention as the preferred treatment for displaced distal clavicle fractures, with the goal of achieving optimal outcomes and minimizing the risk of complications.

From the Research

Treatment Options for Displaced Distal Clavicle Fracture

• Surgical fixation is often recommended for displaced distal clavicle fractures, particularly type II fracture patterns, due to their high rates of nonunion with nonoperative management 2, 3.
• Hook plate fixation has demonstrated reliably high rates of osseous union with good functional outcomes 2.
• Other surgical treatment options include:
  • Coracoclavicular stabilization 3, 4
  • Intramedullary fixation 3
  • Interfragmentary fixation 3
  • K-wire plus tension band wiring 3
• Nonsurgical treatment may be considered as the first line treatment after sufficient counsel with the patient, despite the high nonunion rate, as functional outcomes are generally acceptable in most cases with nonunion 3, 5.
• Open reduction and internal fixation (ORIF) surgery can help restore the clavicle's anatomy and allow patients to rehabilitate sooner, with high rates of bone union and improved functional outcomes 6.

Complications and Considerations

• The nonunion rate is significantly high with nonsurgical treatment 3.
• The complication rate is statistically high with surgery, particularly with hook plate and K-wire plus tension band wiring 3.
• The choice of treatment may be influenced by the amount of fracture displacement and the individual demands of the patient 5.
• Each surgical technique has advantages and disadvantages, and insufficient evidence exists to demonstrate that any one technique consistently provides the best results 5.