Who manages displaced clavicle fractures?

From the Guidelines

Displaced clavicle fractures are typically managed by orthopedic surgeons, who specialize in treating bone and joint injuries. Initially, patients may present to emergency medicine physicians, primary care providers, or sports medicine specialists who will perform preliminary assessment and stabilization before referring to orthopedics for definitive care. Treatment decisions depend on the degree of displacement, with significantly displaced fractures (>2 cm) often requiring surgical intervention, as surgical treatment of displaced midshaft clavicle fractures in adult patients is associated with higher union rates and better early patient-reported outcomes than nonsurgical treatment 1. Surgery typically involves open reduction and internal fixation (ORIF) using plates and screws to realign and stabilize the fracture. Non-operative management with a sling or figure-of-eight brace may be appropriate for minimally displaced fractures, with follow-up at 1-2 weeks and then every 2-4 weeks until healing is complete. Some key points to consider in the management of displaced clavicle fractures include:

• The degree of displacement, with significantly displaced fractures often requiring surgical intervention
• The use of open reduction and internal fixation (ORIF) for surgical treatment
• The importance of follow-up care to monitor for complications such as malunion, nonunion, or hardware issues
• The role of physical therapy in restoring range of motion and strength after the acute phase Orthopedic surgeons manage both the acute treatment and long-term follow-up, monitoring for complications such as malunion, nonunion, or hardware issues. Physical therapy is often prescribed after the acute phase to restore range of motion and strength. Patients should understand that complete healing typically takes 6-12 weeks, with return to full activities including contact sports usually permitted after 3-6 months depending on healing progress, as supported by high-quality evidence showing that higher union rates and better early patient-reported outcomes result after surgical treatment of displaced clavicle fractures in adults 1.

From the Research

Management of Displaced Clavicle Fractures

Displaced clavicle fractures can be managed by various medical professionals, including:

• Orthopedic surgeons, who often perform open reduction and internal fixation (ORIF) surgery to restore the clavicle's anatomy and allow patients to rehabilitate sooner 2
• Trauma specialists, who may be involved in the treatment of complex cases or those with associated injuries
• Physical medicine and rehabilitation (PM&R) physicians, who may help with postoperative rehabilitation and pain management

Treatment Options

The treatment of displaced clavicle fractures can be either nonoperative or operative, with the choice of treatment depending on various factors, including:

• Fracture classification and displacement
• Patient age and overall health
• Presence of associated injuries or complications
• Treatment goals and expectations Operative treatment options include:
• ORIF using plates or other fixation devices 2, 3
• Intramedullary nailing, which can be performed using a mini-invasive technique 3
• Open reduction and internal fixation of associated injuries, such as acromioclavicular dislocations 4

Evidence-Based Practice

Studies have compared the outcomes of operative and nonoperative treatment for displaced midshaft clavicle fractures, with some showing:

• Improved functional outcomes and reduced nonunion rates with ORIF 5
• Similar late functional outcomes and subsequent surgery rates between ORIF and nonoperative treatment 5
• A lack of compelling evidence to support operative treatment over nonoperative treatment 6