What is the preferred method of immobilization for a clavicle fracture, a sling or a collar and cuff?

From the Guidelines

A sling is the preferred method of immobilization for a clavicle fracture. For most clavicle fractures, a simple arm sling provides adequate support and immobilization while allowing the fracture to heal properly, as suggested by the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1. The sling should be worn for approximately 2-6 weeks depending on fracture severity and healing progress. When applying the sling, ensure it supports the entire forearm and elbow, with the arm positioned slightly forward across the chest. This position reduces downward pull on the shoulder girdle and minimizes displacement at the fracture site. Some key points to consider when using a sling for clavicle fracture immobilization include:

• The sling should be worn at all times, except when performing gentle exercises to prevent stiffness in the fingers, wrist, and elbow
• Patients should avoid shoulder movement until cleared by their healthcare provider
• The sling works by limiting shoulder movement and supporting the weight of the arm, which reduces pain and promotes proper bone alignment during healing A collar and cuff is generally less effective for clavicle fractures as it provides insufficient support to the shoulder complex and may allow excessive movement at the fracture site, which can lead to poor healing outcomes and increased morbidity. In the absence of reliable evidence comparing the two methods, the opinion of the work group is that a sling is preferred in most cases for immobilization of acute clavicle fractures, as opposed to a figure-of-eight brace or collar and cuff 1.

From the Research

Immobilization Methods for Clavicle Fractures

The preferred method of immobilization for a clavicle fracture can vary depending on the type and severity of the fracture.

• A sling or figure-of-eight bandage is commonly used for non-displaced or minimally displaced fractures of the middle third of the clavicle 2.
• For more severe fractures, such as those with significant displacement or comminution, surgical intervention may be necessary 3, 4, 5.
• The use of a collar and cuff is not typically recommended for immobilization of clavicle fractures, as it may not provide sufficient support or stability for the fracture 6.

Considerations for Treatment

When deciding on a treatment plan for a clavicle fracture, several factors should be considered, including:

• The location and severity of the fracture
• The patient's age and activity level
• The presence of any associated injuries or complications
• The patient's preferences and goals for treatment 3, 4, 5
• The potential risks and benefits of surgical versus conservative treatment, including the risk of non-union, malunion, and other complications 3, 5

Current Concepts and Evidence

Recent studies have highlighted the importance of individualizing treatment for clavicle fractures based on the specific characteristics of the fracture and the patient 6, 4, 5.

• The use of surgical fixation for clavicle fractures is becoming more common, particularly for more severe fractures or those with a high risk of non-union or malunion 3, 5.
• However, conservative treatment with immobilization and physical therapy may still be appropriate for many patients, particularly those with non-displaced or minimally displaced fractures 2.