From the Guidelines
Surgical treatment is recommended for overriding clavicle fractures, especially those with significant displacement, to improve union rates and patient-reported outcomes. The treatment of an overriding clavicle fracture typically begins with pain management using NSAIDs like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours), combined with ice application for 15-20 minutes several times daily 1. Most uncomplicated clavicle fractures are treated non-surgically with a figure-of-eight brace or simple sling for 4-8 weeks to immobilize the area while healing occurs. However, recent evidence suggests that 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 1.
Key Considerations
- Surgical intervention with plate and screw fixation may be necessary for severely displaced fractures (over 2cm displacement), shortening greater than 15mm, or when there's risk to surrounding structures.
- Complete healing typically takes 6-12 weeks, though return to full activities may require 3-6 months.
- During recovery, maintaining good posture is essential to ensure proper alignment of the bone.
- Complications like malunion (healing in a misaligned position) can occur with overriding fractures, which is why regular follow-up X-rays are important to monitor healing progress 1.
Treatment Approach
- Physical therapy usually begins after 2-3 weeks of immobilization, focusing first on gentle range of motion exercises and progressing to strengthening exercises as healing advances.
- The choice of surgical technique, such as plate osteosynthesis or intramedullary fixation, depends on the fracture pattern and patient factors.
- A patient-centered discussion leading to an understanding of an individual patient’s values and preferences can inform appropriate decision making 1.
From the Research
Treatment Options for Overriding Clavicle Fracture
- The treatment for an overriding clavicle fracture can be either conservative or operative, depending on the severity and location of the fracture 2, 3.
- Non-displaced fractures are typically treated conservatively, while displaced fractures may require operative treatment, especially in young and active patients 2.
- The decision to operate is based on factors such as the degree of displacement, comminution, and shortening of the fracture, as well as the presence of associated injuries or neurovascular compromise 3, 4.
Healing Process
- The healing process for an overriding clavicle fracture can be influenced by the treatment approach, with operative treatment leading to significantly increased rates of union 5.
- Studies have shown that superior clinical results are found in patients with united clavicle fractures rather than those that go on to non-union 5.
- The use of a sling for immobilization and multimodal pain control can help manage symptoms and promote healing in non-operatively managed fractures 4.
Specific Considerations
- Pediatric fractures are generally managed conservatively, with adolescents older than 9 years-old for girls and 12 years-old for boys being treated using algorithms that are similar to adults 4.
- Emergent referral is indicated for open fractures, posteriorly displaced proximal fractures, and those with emergent associated injuries, while urgent referral is warranted for fractures with greater than 100% displacement or other complex fracture patterns 4.