From the Guidelines
Clavicle fractures are typically treated with surgical intervention for significantly displaced fractures, while non-displaced or minimally displaced fractures can be managed conservatively, as evidenced by the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1. The treatment of clavicle fractures depends on the type of fracture, displacement, and patient factors.
- Clavicle fractures can be classified into three main types based on their location: middle third (most common, accounting for 80% of cases), distal third, and proximal third fractures.
- For non-displaced or minimally displaced fractures, conservative management is typically recommended, consisting of a sling or figure-of-eight bandage for 2-6 weeks, pain control with acetaminophen or NSAIDs (ibuprofen 400-600mg every 6 hours or naproxen 500mg twice daily), and progressive range of motion exercises after initial immobilization.
- Surgical treatment is indicated for significantly displaced fractures (>2cm displacement), open fractures, skin tenting, neurovascular compromise, or fractures with high risk of non-union.
- Surgical options include plate fixation with screws or intramedullary fixation, followed by a brief period of immobilization and then rehabilitation.
- Complications of clavicle fractures include malunion, non-union, and neurovascular injuries.
- Recovery typically takes 6-12 weeks, with return to full activities including sports usually possible by 3-4 months.
- Regular follow-up with radiographs is important to ensure proper healing, especially in the first 4-6 weeks after injury. According to the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures, 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. However, for adolescent patients with displaced midshaft clavicle fractures, surgical treatment may offer no benefit compared with nonsurgical treatment, as it is associated with similar union rates and substantial revision surgery rates for implant removal 1. The American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures provides a strong recommendation on surgical versus nonsurgical treatment of displaced clavicle fractures in adults, with 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. In summary, the treatment of clavicle fractures should be individualized based on the type of fracture, displacement, and patient factors, with surgical intervention considered for significantly displaced fractures and conservative management for non-displaced or minimally displaced fractures.
From the Research
Types of Clavicular Fractures
- Mid-shaft clavicular fractures account for the majority of all clavicular fractures, with approximately 69% to 81% of all clavicle fractures occurring in this region 2
- Fractures can be classified as nondisplaced or displaced, with displaced fractures being further subdivided into comminuted or non-comminuted fractures
- The location of the fracture can also be classified as proximal, mid-shaft, or distal third of the clavicle
Treatment Options for Clavicular Fractures
- Non-operative treatment, including the use of a figure-of-eight bandage or a sling, is often the preferred method for treating nondisplaced mid-shaft clavicle fractures 2, 3
- Surgical options, such as open reduction and internal fixation (ORIF) with plates or intramedullary pins, may be considered for displaced or comminuted fractures, or for patients who require early functional recovery 4, 5, 6
- The choice of treatment depends on various factors, including the severity of the fracture, the patient's age and activity level, and the presence of any associated injuries or complications
Outcomes of Treatment for Clavicular Fractures
- Studies have shown that surgical treatment, such as ORIF, can result in faster union times, lower rates of malunion and nonunion, and improved functional outcomes compared to non-operative treatment 4, 6
- However, surgical treatment is also associated with a risk of complications, such as adhesive capsulitis or stiffness, paresthesia, and superficial infection 6
- Non-operative treatment, on the other hand, may result in longer union times and higher rates of malunion and nonunion, but is often associated with fewer complications and a lower risk of surgical site infections 2, 3