From the Guidelines
The recommended non-operative management for an elderly patient with a non-displaced or minimally displaced clavicular fracture includes a brief period of immobilization with a simple sling for 2-3 weeks for comfort, followed by progressive mobilization as pain allows. Pain management should consist of acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) as first-line therapy, with NSAIDs like ibuprofen (400-600mg three times daily with food) used cautiously in patients without contraindications. Early pendulum exercises can begin after 1-2 weeks, progressing to active range of motion exercises at 3-4 weeks as tolerated. Clinical follow-up should occur at 2 weeks and 6 weeks with radiographs to ensure proper healing. Most elderly patients can expect functional recovery within 6-12 weeks, though some residual bump at the fracture site is common and benign. This conservative approach is appropriate because non-displaced clavicular fractures in the elderly typically heal well without surgery, and avoiding operative intervention reduces risks of anesthesia complications, surgical site infections, and hardware problems in this population, as supported by recent guidelines 1. Patients should be advised that early mobilization, within pain limits, promotes better long-term shoulder function and prevents stiffness that can occur with prolonged immobilization.
Key considerations in the management of these patients include:
- A multidisciplinary approach to care, especially in the frail elderly, as recommended by EULAR/EFORT 1
- Systematic investigation of future fracture risk in all elderly patients with a recent fracture
- Appropriate non-pharmacological and pharmacological treatment to decrease the risk of subsequent fracture in high-risk patients
- The importance of a coordinator to setup a process for the systematic investigations for future fracture risk and to ensure that high-risk patients receive appropriate treatment.
Overall, the goal of non-operative management is to promote healing, minimize complications, and optimize functional recovery, while also considering the patient's overall health and risk factors for future fractures.
From the Research
Non-Operative Management of Clavicular Fractures in the Elderly
The recommended non-operative management for an elderly patient with a non-displaced or minimally displaced clavicular fracture includes:
- Immobilization with a sling to reduce pain and promote healing 2
- Multimodal pain control to manage discomfort and pain associated with the fracture 2
- Regular follow-up with an orthopedic specialist to monitor the fracture's progression and detect any potential complications 2
Indications for Non-Operative Management
Non-operative management is typically indicated for:
- Non-displaced or minimally displaced fractures with no instability or associated neurovascular injury 2
- Fractures with minimal shortening or comminution 2
- Patients who are not candidates for surgical intervention due to underlying medical conditions or other factors 3, 4, 5
Potential Complications
Elderly patients with clavicular fractures are at risk for potential complications, including:
- Nonunion or malunion of the fracture 6, 3, 4, 5
- Neurovascular injury or compromise 2
- Decreased range of motion or strength in the affected shoulder 3, 4, 5
Treatment Algorithms
Treatment algorithms for clavicular fractures vary depending on the location and severity of the fracture, as well as the patient's age and overall health status 3, 4, 5, 2