What is the treatment for a clavicle (collar bone) fracture?

Treatment of Clavicle (Collar Bone) Fractures

For most clavicle fractures, non-surgical treatment with a simple arm sling is the recommended approach, as it provides better pain control and similar functional outcomes compared to figure-of-eight bandages. 1, 2

Treatment Algorithm Based on Fracture Type

Midshaft Clavicle Fractures (80% of cases)

• Non-displaced fractures:

  • Simple arm sling for 2-6 weeks 1, 2
  • Early mobilization and gradual return to activities as tolerated
  • Follow-up radiographs to ensure proper healing

• Displaced midshaft fractures:

  • Surgical indications (plate fixation recommended):
    • Displacement greater than one shaft width
    • Shortening greater than 1 cm
    • Patients with high physical activity requirements
    • Severe angulation or comminution 1, 3
  • Non-surgical treatment for all others:
    • Simple arm sling (preferred over figure-of-eight bandage) 1, 2

Distal Clavicle Fractures

• With disruption of coracoclavicular ligaments:
  • Surgical treatment recommended to improve union rates and functional outcomes 1
• Without ligament disruption:
  • Non-surgical treatment with arm sling 1

Proximal Clavicle Fractures

• Generally stable and respond well to non-surgical treatment with arm sling

Important Clinical Considerations

Benefits of Arm Sling vs. Figure-of-Eight Bandage

• Arm sling provides better pain control (lower VAS pain scores) 2
• Easier application compared to figure-of-eight bandage 2
• Similar functional outcomes and healing rates 2

Risk Factors for Poor Outcomes

• Smoking increases nonunion risk 1
• Severe displacement or comminution may require surgical intervention 1, 3

Special Populations

• Children: Excellent healing potential with non-surgical treatment; prominent callus formation is common and normal 4
• Adolescents: May not benefit from surgical treatment even with displacement 1
• Patients with neuromuscular disorders: May require surgical fixation due to inability to tolerate prolonged immobilization 3

Imaging Considerations

• Upright radiographs are superior for evaluating displacement compared to supine views 1

Follow-up and Rehabilitation

• Regular follow-up with radiographs to ensure proper healing
• Early range of motion exercises as pain allows
• Gradual return to activities based on clinical and radiographic healing
• Most patients can expect full recovery of function with appropriate treatment 5

Surgical Considerations (when indicated)

• Anatomic contoured plates preferred over standard plates 1
• Anterior-inferior plating may lead to lower implant removal rates 1
• Plate fixation preferred over intramedullary nailing for comminuted fractures 1

Common Pitfalls to Avoid

1. Overuse of figure-of-eight bandages, which cause more pain and are more difficult to apply
2. Failure to identify indications for surgical intervention in significantly displaced fractures
3. Unnecessary surgical intervention for minimally displaced fractures
4. Ignoring patient-specific factors like activity level and occupation when making treatment decisions

Remember that while most clavicle fractures heal well with non-surgical treatment, proper assessment of displacement, shortening, and patient factors is essential to determine the optimal treatment approach.