What are the treatment options for a clavicle fracture?

Treatment Options for Clavicle Fractures

The treatment of clavicle fractures should be based on fracture location, displacement, and patient factors, with surgical treatment of displaced midshaft fractures in adults showing higher union rates and better early outcomes compared to nonsurgical treatment, though both approaches yield similar long-term results.

Nonsurgical Treatment Options

• A sling is the preferred immobilization method for most acute clavicle fractures rather than a figure-of-eight brace 1

• Nonsurgical management is appropriate for:

  • Non-displaced fractures 1
  • Minimally displaced fractures with shortening less than 1.5cm 2
  • Most clavicle fractures in adolescents (under 18 years), as surgical treatment offers no significant benefit and carries substantial risk of requiring revision surgery for implant removal 1

• Upright radiographs are recommended for assessment as they better demonstrate the degree of displacement compared to supine radiographs 1

• Low-intensity pulsed ultrasonography (LIPUS) should not be used for nonsurgical management of acute midshaft clavicle fractures as it does not accelerate healing or reduce nonunion rates 1

Surgical Treatment Options

• Surgical treatment is indicated for:

  • Displaced midshaft fractures in adults (especially active individuals) with shortening exceeding 1.5cm 1, 2
  • Open fractures or those with neurovascular complications 2
  • Displaced lateral fractures with disruption of the coracoclavicular ligament complex 1
  • Floating shoulder injuries 2

• Surgical options include:

  • Plate fixation: Manufacturer-contoured anatomic clavicle plates are preferred as they have lower rates of implant removal or deformation compared to non-precontoured plates 1
  • Anterior inferior plating may lead to lower implant removal rates compared with superior plating 1
  • Intramedullary nailing: Provides equivalent long-term clinical outcomes to plate fixation with similar complication rates 1
  • Plate fixation may be more beneficial in cases with fracture comminution 1

Special Considerations

• Smoking increases the rate of nonunion in clavicle fractures and leads to inferior clinical outcomes 1

• For adults with displaced midshaft clavicle fractures:

  • Surgical treatment provides higher union rates and better early patient-reported outcomes 1
  • Faster time to union with surgical treatment may benefit patients seeking quick return to work or sports 1, 3
  • Long-term patient-reported outcomes and satisfaction are similar between surgical and nonsurgical approaches 1

• For lateral clavicle fractures with coracoclavicular ligament disruption, surgical repair may be beneficial, though evidence is limited 1

Rehabilitation

• Rehabilitation should include:

  • Muscle strengthening exercises 4
  • Long-term continuation of appropriate exercises 4
  • Patient education about pain management strategies 4
  • Monitoring for signs of complications requiring medical attention 4

• Kinesiotaping therapy combined with arm sling may yield better clinical functional results, higher union rates, and shorter time to return to work compared to arm sling alone for minimally displaced midshaft fractures 5

Potential Complications

• Nonsurgical treatment of widely displaced fractures may result in:

  • Higher nonunion rates (up to 15%) 1, 3
  • Symptomatic malunion affecting shoulder strength and function 1, 2
  • Cosmetic concerns 1
  • Longer time to return to work 1, 5

• Surgical complications may include:

  • Need for hardware removal (particularly with non-precontoured plates) 1
  • Rare iatrogenic vascular complications 2
  • Infection and hardware failure 3