From the Guidelines
Surgical treatment is recommended for a displaced left mid clavicle fracture, as it is associated with higher union rates and better early patient-reported outcomes compared to nonsurgical treatment. This is based on the most recent and highest quality study, which suggests that surgical treatment of displaced midshaft clavicle fractures in adult patients results in equivalent or improved short-term patient-reported outcomes and reduced rates of nonunion or symptomatic malunion when compared with nonsurgical treatment 1.
The management of a displaced left mid clavicle fracture typically involves:
- Initial pain control with acetaminophen (500-1000mg every 6 hours) and/or NSAIDs like ibuprofen (400-600mg every 6-8 hours) if not contraindicated
- Immobilization with a sling or figure-of-eight brace for 2-6 weeks to reduce pain and support the fracture while it heals
- Surgical fixation with plates and screws for significantly displaced fractures (more than 2cm displacement or shortening) to restore normal alignment and function
- Complete healing typically takes 6-12 weeks, with gradual return to activities as pain subsides
- Physical therapy is often beneficial after the initial healing period to restore range of motion and strength
It is essential to note that complications can include malunion, nonunion, or damage to surrounding structures, so proper treatment is crucial 1. Additionally, smoking cessation and adequate nutrition with sufficient protein and calcium intake will support optimal bone healing. The American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures recommends surgical treatment for displaced midshaft clavicle fractures in adult patients, with a strong recommendation for this approach 1.
From the Research
Displaced Left Mid Clavicle Fracture
- A displaced left mid clavicle fracture is a common injury, with most clavicle fractures occurring in the middle third of the clavicle 2, 3.
- The treatment of displaced midshaft clavicle fractures is still debatable, with some studies suggesting that operative treatment leads to improved short-term functional outcomes and lower rates of non-union compared to conservative treatment 4, 5.
- However, operative treatment is also associated with an increased risk of complications and re-operations, while long-term shoulder functional outcomes are similar 4, 5.
- The optimal treatment strategy should be tailored to the patient and their specific needs and expectations, using a shared decision-making model 5.
- A survey of orthopedic surgeons found that 49% preferred operative treatment for a displaced middle-third clavicular fracture, with most surgeons preferring a locking plate for fixation 6.
- The treatment approach for a displaced middle-third clavicular fracture seems to be evenly split between conservative and operative approaches, with the tendency towards operative treatment being more remarkable among orthopedic trauma specialists and shoulder specialists 6.
Treatment Options
- Conservative treatment: may be suitable for non-displaced or minimally displaced fractures, but may result in higher rates of non-union and malunion 2, 3.
- Operative treatment: may be suitable for displaced or shortened midshaft clavicle fractures, and can lead to improved short-term functional outcomes and lower rates of non-union 4, 5.
- Plate fixation: is a common method of operative treatment, with most surgeons preferring a locking plate for fixation 6.
- Intramedullary fixation: is another method of operative treatment, which can be used for certain types of fractures 4.