What is the recommended management for an acute minimally displaced distal clavicular fracture?

Management of Acute Minimally Displaced Distal Clavicular Fracture

Nonsurgical management is the recommended treatment for minimally displaced distal clavicular fractures, as these fractures typically heal well with conservative treatment and have low nonunion rates. 1

Conservative Management Approach

Initial Treatment

• Immobilization: Use a sling rather than a figure-of-eight brace for comfort and proper healing
  • The American Academy of Orthopaedic Surgeons (AAOS) specifically recommends sling immobilization over figure-of-eight braces for acute clavicle fractures 1
  • Duration: 4-6 weeks of functional support is preferred 2

Pain Management

• Ice application during the first 3-5 days for symptomatic relief 2
• Appropriate analgesics as needed

Rehabilitation Protocol

• Begin active finger motion exercises immediately to prevent stiffness 2
• After the immobilization period:
  • Progressive range of motion exercises
  • Directed home exercise program
  • Gradual return to activities 2

Monitoring and Follow-up

• Radiographic follow-up at 3 weeks and at cessation of immobilization
  • Upright radiographs are superior for demonstrating the degree of displacement compared to supine radiographs 1
• Approximately 90% of fractures unite within 12 weeks 2

Important Considerations

When to Consider Surgical Intervention

While minimally displaced fractures generally do well with conservative treatment, surgical intervention should be considered if:

• Displacement increases to >5mm in any plane during follow-up
• There is disruption of the coracoclavicular ligament complex
• The fracture becomes unstable

The AAOS guideline specifically states that "displaced lateral fractures with disruption of the coracoclavicular ligament complex may benefit from surgical repair" 1

Risk Factors for Poor Outcomes

• Smoking increases the rate of nonunion and leads to inferior clinical outcomes 1
• Advise patients who smoke to quit during the healing process

Avoid Unnecessary Interventions

• Low-intensity pulsed ultrasonography (LIPUS) should NOT be used as it does not accelerate healing or lower rates of nonunion 1, 2

Special Populations

• Elderly patients: Consider evaluation for osteoporosis risk, calcium and vitamin D supplementation, and fall risk assessment 2

Prognosis

Despite relatively higher nonunion rates compared to other clavicle fracture types, minimally displaced distal clavicle fractures managed conservatively typically have good subjective and functional outcomes 3. Most patients can expect excellent functional recovery with appropriate conservative management.