How long should a patient wear a sling or remain non-weightbearing after an Open Reduction Internal Fixation (ORIF) procedure for a clavicle fracture?

Duration of Sling Use and Weight-bearing Restrictions After ORIF for Clavicle Fracture

Patients should wear a sling for 2-4 weeks after ORIF for clavicle fracture, with gradual return to weight-bearing activities after this period as tolerated. 1

Immediate Post-operative Period (0-2 weeks)

• The American Academy of Orthopaedic Surgeons (AAOS) recommends a sling as the preferred immobilization method for acute clavicle fractures rather than a figure-of-eight brace 1
• During the first 2 weeks, the sling should be worn consistently except during hygiene activities and gentle range of motion exercises as directed by the surgeon 1
• Early controlled shoulder mobilization should begin within the first week to prevent stiffness while protecting the surgical construct 1

Early Rehabilitation Phase (2-4 weeks)

• After 2 weeks, patients may begin to gradually decrease sling use while continuing to avoid weight-bearing through the affected upper extremity 1
• Gentle passive and active-assisted range of motion exercises can be progressed during this period under the guidance of physical therapy 1
• By 4 weeks, most patients can discontinue sling use entirely for routine activities but should continue to avoid lifting, pushing, or pulling with the affected arm 2

Progressive Weight-bearing (4-6 weeks)

• After 4 weeks, patients can typically begin light weight-bearing activities (less than 5 pounds) as tolerated 1
• Recent evidence challenges traditional weight-bearing restrictions, with one study showing that immediate weight-bearing as tolerated (WBAT) through walker or crutches after clavicle ORIF did not increase hardware failure rates compared to non-weight-bearing protocols 3
• This study found no difference in union rates between immediate WBAT and non-weight-bearing groups, suggesting earlier mobilization may be safe in appropriate patients 3

Return to Full Activities (6-12 weeks)

• Progressive return to normal activities can begin at 6 weeks post-surgery, with gradual increase in weight-bearing as tolerated 1
• Full weight-bearing activities are typically allowed between 8-12 weeks, depending on radiographic evidence of healing and clinical examination 2
• Return to high-impact activities, contact sports, or heavy manual labor should be delayed until 12 weeks or when there is radiographic evidence of union 1

Special Considerations

• Patients with comminuted fractures, osteoporosis, or other risk factors may require longer periods of protection and more gradual return to weight-bearing activities 4
• Smoking significantly increases the risk of complications and may necessitate longer weight-bearing restrictions 4
• Patients with transverse or Z-type fractures have higher complication rates and may benefit from more conservative weight-bearing progression 4

Monitoring for Complications

• Regular follow-up with radiographic assessment is essential to monitor healing and detect early signs of hardware failure or nonunion 5
• The most common complication requiring reoperation is symptomatic hardware (18.8%), with females at higher risk (OR 1.7) 5
• Nonunion occurs in approximately 2.6% of cases, with risk factors including female sex and higher comorbidity scores 5
• Patients should be monitored for rare but serious complications such as brachial plexus injury, which requires immediate intervention if detected 6

Conclusion

While traditional protocols have emphasized prolonged sling use and weight-bearing restrictions, emerging evidence suggests that earlier mobilization may be safe for many patients without increasing complication rates. The decision regarding duration of sling use and weight-bearing restrictions should be based on fracture characteristics, fixation stability, and individual patient factors.