From the Guidelines
The initial management of a left midshaft clavicular fracture with slight angulation in the Emergency Department involves conservative treatment with a simple sling or figure-of-eight bandage for immobilization. This approach is supported by the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1, which suggests that many clavicle fractures can be managed successfully without surgery, especially those with minimal displacement.
Pain control should be achieved with acetaminophen 650-1000mg every 6 hours and/or ibuprofen 400-600mg every 6-8 hours as needed, with stronger analgesics like oxycodone 5-10mg every 4-6 hours reserved for severe pain. Ice should be applied for 20 minutes every 2-3 hours for the first 48-72 hours to reduce swelling and pain. The patient should be instructed to maintain the immobilization for 2-6 weeks and referred to orthopedics for follow-up within 7-10 days.
Most midshaft clavicular fractures with minimal displacement heal well with conservative management, as the clavicle has excellent blood supply and healing potential. Surgery is typically not indicated for minimally displaced fractures unless there are specific complications like neurovascular compromise, open fracture, or significant displacement (>2cm) 1. The patient should be advised to avoid heavy lifting and contact sports until cleared by the orthopedic specialist, usually after clinical and radiographic evidence of healing.
Key considerations in the management of clavicle fractures include:
- Immobilization to reduce pain and promote healing
- Pain management with analgesics
- Follow-up with orthopedics to assess healing and guide return to activity
- Avoidance of heavy lifting and contact sports until healing is confirmed
- Consideration of surgical intervention for complications or significant displacement, as supported by recent studies 1.
From the Research
Initial Management of Left Midshaft Clavicular Fracture with Slight Angulation
The initial management of a left midshaft clavicular fracture with slight angulation in the Emergency Department (ED) involves immobilization and referral to orthopedics.
- Immobilization can be achieved with a sling or figure-of-8 dressing to provide support and comfort to the patient 2.
- Referral to orthopedics is necessary for further evaluation and management, as the risk of nonunion and poor functional outcome may be higher than previously thought, especially in cases with initial fracture displacement, comminution, shortening, and older age 3.
- The decision for operative or nonoperative management depends on various factors, including the degree of displacement, comminution, and patient characteristics, such as age and activity level 2, 4, 5.
- Nonoperative treatment is often recommended for nondisplaced or minimally displaced midshaft fractures, while operative management may be considered for completely displaced or comminuted fractures, especially in elderly patients or those with a high risk of nonunion 2, 5.
- Studies have shown that operative management can result in improved functional outcomes, decreased time to union, and early return to activity, especially in young active adults 6, 5.