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 than nonsurgical treatment. According to the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1, surgical treatment of displaced clavicle fractures results in equivalent or improved short-term patient-reported outcomes and reduced rates of nonunion or symptomatic malunion when compared with nonsurgical treatment.
The treatment approach for a displaced left mid clavicle fracture should be determined by an orthopedic consultation. Key considerations for surgical treatment include:
- Higher union rates
- Better early patient-reported outcomes
- Reduced rates of nonunion or symptomatic malunion
- Faster functional and radiographic recovery, allowing for earlier return to work
As noted in the clinical practice guideline summary 1, surgical treatment of displaced midshaft clavicle fractures in adult patients is associated with higher union rates and better early patient-reported outcomes than nonsurgical treatment, with a strong recommendation for surgical treatment. However, practitioners may consider either surgical or nonsurgical treatment because both are associated with similar long-term patient-reported outcomes and patient satisfaction.
During the healing period, it is essential to:
- Avoid heavy lifting and strenuous activities involving the affected arm
- Begin gentle pendulum exercises after 1-2 weeks as pain allows, followed by progressive range of motion exercises under guidance
- Regular follow-up with x-rays is important to ensure proper healing and alignment. Pain control using acetaminophen (500-1000mg every 6 hours) and/or ibuprofen (400-600mg every 6-8 hours) as needed should also be considered.
From the Research
Displaced Left Mid Clavicle Fracture
- A displaced left mid clavicle fracture is a common injury, accounting for 2.6% to 4% of all fractures, with 80% of clavicle fractures located in the middle third of the clavicle 2.
- The treatment of displaced mid clavicle fractures is debatable, with some studies suggesting that surgical treatment may not improve upper arm function at follow-up of one year or longer, but may reduce the risk of treatment failure 2.
- Surgical treatment of displaced mid clavicle fractures may result in fewer treatment failures, such as non-union or malunion, but may also increase the risk of complications, such as infection or hardware irritation 2, 3, 4.
Treatment Options
- Conservative treatment, such as wearing a sling or figure-of-eight bandage, is often used for non-displaced fractures, but may not be sufficient for displaced fractures 2, 5.
- Surgical treatment, such as open reduction and internal fixation, may be considered for displaced fractures, especially in young and active patients 3, 4, 5.
- The choice of treatment should be individualized, taking into account the patient's specific needs and expectations, as well as the potential risks and benefits of each treatment option 4, 5.
Current Concepts
- Recent studies suggest that operative treatment of displaced mid clavicle fractures may lead to improved short-term functional outcomes, increased patient satisfaction, and an earlier return to sports, but may not improve long-term shoulder functional outcomes 4.
- The use of a locking plate for fixation is a common approach for surgical treatment of displaced mid clavicle fractures 6.
- A treatment algorithm is proposed, with non-displaced fractures treated conservatively and operative treatment considered for displaced fractures, especially in young and active patients 5.