What is the appropriate management for a patient presenting with a closed fracture of the manubrium, a closed left scapular fracture, and a clavicular fracture?

From the Guidelines

The management of a patient presenting with a closed fracture of the manubrium, a closed left scapular fracture, and a clavicular fracture should prioritize surgical intervention for the clavicular fracture, especially if it is widely displaced, to minimize the risk of malunion and nonunion, as supported by recent evidence 1. The patient's treatment plan should be multifaceted, addressing pain management, immobilization, and rehabilitation. For pain control, analgesics such as acetaminophen 1000mg every 6 hours and/or ibuprofen 400-600mg every 6 hours can be administered. In cases of more severe pain, short-term opioids like oxycodone 5-10mg every 4-6 hours for 3-5 days may be considered.

Immobilization and Rehabilitation

• Immobilize the shoulder complex with a sling or figure-of-eight bandage for 4-6 weeks to stabilize the fractures and reduce pain during healing.
• Physical therapy should begin after 2-3 weeks of immobilization, focusing on gentle range of motion exercises before progressing to strengthening exercises.

Surgical Intervention

Surgical intervention is particularly recommended for the clavicular fracture if it is widely displaced, given the increasing evidence that nonsurgical management of such fractures often results in malunions, which may have adverse effects on strength and function of the shoulder 1. The choice between different surgical techniques, such as plate osteosynthesis or intramedullary fixation, should be based on the fracture pattern and the patient's specific needs.

Follow-Up

Regular follow-up with orthopedics at 1-2 weeks, then every 2-4 weeks with serial radiographs, is essential to monitor healing and address any potential complications early. This approach allows for proper bone healing while minimizing complications such as malunion, nonunion, or shoulder dysfunction. The management plan should be tailored to the individual patient's needs, taking into account the severity of the fractures, the patient's overall health, and their functional requirements.

From the Research

Management of Closed Fractures

The management of a patient presenting with a closed fracture of the manubrium, a closed left scapular fracture, and a clavicular fracture involves a thorough assessment of the fractures and evaluation of other injuries.

• The patient should be carefully observed for complications, and reduction should be performed as indicated 2.
• For clavicle fractures, non-displaced fractures are typically treated conservatively, while operative treatment may be discussed with patients who have displaced fractures, especially young and active patients 3, 4, 5.
• The treatment of scapula fractures depends on the location and displacement of the fracture, with relative indications for surgical treatment including displaced acromion or coracoid process fractures, displaced intra-articular glenoid fractures, and those associated with humeral subluxation 4.
• Nonoperative methods for closed fractures can be a preferable option, associated with lower infection rates, rapid functional improvements, and lower healthcare costs, especially for patients with higher surgical risks 6.

Treatment Options

• Conservative treatment options include immobilization and pain management.
• Operative treatment options for clavicle fractures include superior plating, anterior-inferior plating, dual plating, and intramedullary nail fixation 5.
• The choice of treatment depends on the individual patient's condition, the severity of the fractures, and the presence of other injuries.

Considerations

• The patient's overall health and medical history should be taken into account when determining the best course of treatment.
• The potential risks and benefits of operative versus nonoperative treatment should be discussed with the patient, including the risk of nonunion, infection, and other complications 3, 4, 5, 6.