From the Guidelines
The initial management for a mildly angulated midshaft fracture of the left clavicle typically involves non-operative treatment with a simple sling or figure-of-eight bandage for 2-6 weeks. This approach is supported by recent evidence from the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1. According to this guideline, many clavicle fractures can be managed successfully without surgery, with a low nonunion rate, particularly for those with minimal displacement.
Pain control should be achieved with acetaminophen (500-1000mg every 6 hours) and/or NSAIDs like ibuprofen (400-600mg every 6-8 hours) as needed, with stronger analgesics such as tramadol (50-100mg every 6 hours) reserved for severe pain in the first few days. Ice packs applied for 15-20 minutes several times daily for the first 48-72 hours can help reduce swelling and pain. Activity modification is necessary, avoiding lifting the affected arm above shoulder level or carrying weights exceeding 5-10 pounds until clinical healing occurs, typically within 6-8 weeks.
Some key points to consider in the management of mildly angulated midshaft clavicle fractures include:
- The rich blood supply to the clavicle promotes healing, and the surrounding musculature provides natural stabilization 1.
- Follow-up should occur at 2 weeks to assess pain control and at 6 weeks to evaluate healing with radiographs.
- Physical therapy may be initiated after 4-6 weeks to restore range of motion and strength.
- While surgical treatment may be considered for widely displaced fractures, the current evidence suggests that nonsurgical management is appropriate for mildly angulated fractures, with similar long-term patient-reported outcomes and patient satisfaction 1.
Overall, the management of mildly angulated midshaft clavicle fractures should prioritize non-operative treatment, with a focus on pain control, activity modification, and follow-up to assess healing and initiate physical therapy as needed.
From the Research
Initial Management for Mildly Angulated Midshaft Fracture of the Left Clavicle
The initial management for a mildly angulated midshaft fracture of the left clavicle typically involves conservative treatment.
- The use of a figure-of-eight bandage is a common approach, as seen in 2 where 88% of hospitals used this method for simple fractures.
- Another option is the use of an arm sling, which can be used alone or in combination with other therapies such as kinesiotaping, as studied in 3.
- The decision to use operative treatment, such as plate fixation, is usually reserved for more complex cases, including severely displaced or comminuted fractures, young and active adults, or cases with additional injuries in the shoulder region, as indicated in 2 and 4.
- The choice of treatment depends on various factors, including the severity of the fracture, the patient's age and activity level, and the presence of any additional injuries, as discussed in 5 and 6.
Considerations for Treatment
- Non-operative treatment is often the preferred approach for mildly angulated midshaft fractures, as it can be effective in promoting healing and minimizing complications, as seen in 4 and 3.
- Operative treatment may be considered for cases with a high risk of nonunion or malunion, or for patients who require early return to function, as discussed in 2 and 5.
- The use of kinesiotaping therapy, as studied in 3, may be a useful adjunct to traditional conservative treatment, as it can help reduce pain and promote healing.
- The treatment approach should be individualized based on the specific needs and circumstances of each patient, taking into account factors such as age, activity level, and overall health, as considered in 6.