What is the proper method for splinting a fractured clavicle?

Splinting a Broken Clavicle

A simple arm sling is the preferred method for immobilizing acute clavicle fractures rather than a figure-of-eight brace, as recommended by the American Academy of Orthopaedic Surgeons. 1

Rationale for Sling Immobilization

The 2023 American Academy of Orthopaedic Surgeons (AAOS) clinical practice guideline clearly states that in the absence of reliable evidence, it is the opinion of their work group that a sling is preferred in most cases for immobilization of acute clavicle fractures as opposed to a figure-of-eight brace. 1

This recommendation is supported by research showing that:

• Patients experience significantly more pain on the first day after treatment with figure-of-eight bandages compared to those treated with arm slings (VAS 6.8 vs 5.6) 2
• Application of the figure-of-eight bandage is more difficult than a simple arm sling 2
• Both methods result in similar functional outcomes and healing rates 2

Proper Splinting Technique

Materials Needed:

• Arm sling (triangular bandage or commercial sling)
• Padding material
• Ice pack (for initial management)

Step-by-Step Application:

1. Position the patient in an upright sitting position
2. Apply adequate padding over the clavicle area if needed for comfort
3. Place the forearm of the affected side across the chest in a slightly elevated position
4. Apply the sling under the forearm and around the neck
5. Ensure the elbow is flexed at approximately 90 degrees
6. Adjust the sling so that the wrist is supported and the hand is slightly elevated above elbow level
7. Secure the sling with appropriate fasteners (Velcro or ties)
8. Check that the sling is snug but not too tight to avoid neurovascular compromise

Duration of Immobilization

• Maintain immobilization for approximately 2-6 weeks depending on:
  • Patient age
  • Fracture type
  • Healing progression
• Follow-up radiographs should be obtained to assess healing progress

Important Considerations

Patient Instructions

• Maintain the sling at all times except for hygiene purposes
• Avoid lifting the affected arm above shoulder level
• Perform gentle pendulum exercises as directed by healthcare provider
• Apply ice for 15-20 minutes several times daily for the first 48-72 hours

When to Consider Surgical Management

Surgical treatment may be considered for:

• Significantly displaced midshaft fractures in adults with high functional demands 1
• Displaced lateral fractures with disruption of the coracoclavicular ligament complex 1

Monitoring and Follow-up

• Initial follow-up within 1-2 weeks to assess position and early healing
• Subsequent follow-up at 4-6 weeks to evaluate bone union
• Upright radiographs are superior for demonstrating the degree of displacement in midshaft clavicle fractures compared with supine radiographs 1

Common Pitfalls to Avoid

1. Using figure-of-eight bandages routinely: Despite traditional practice, these cause more pain and are more difficult to apply with no proven benefit over simple slings 2

2. Inadequate immobilization: Ensure the sling properly supports the weight of the arm to reduce stress on the fracture site

3. Overlooking distal clavicle fractures: These may be difficult to distinguish from acromioclavicular separations and require careful radiographic assessment 3

4. Failing to counsel patients about smoking: Smoking increases the rate of nonunion in clavicle fractures and leads to inferior clinical outcomes 1

5. Using bone stimulators: Low-intensity pulsed ultrasonography (LIPUS) should not be used for nonsurgical management of acute mid-shaft clavicle fractures as it does not result in accelerated healing or lower rates of nonunion 1