What is the treatment for a clavicle fracture?

Treatment of Clavicle Fractures

The treatment of clavicle fractures primarily involves nonsurgical management with a sling for most non-displaced fractures, while surgical intervention is indicated for specific cases such as displaced midshaft fractures with shortening exceeding 1.5cm or displaced lateral fractures with disruption of the coracoclavicular ligament complex. 1

Initial Assessment and Classification

• Upright radiographs are recommended for proper assessment as they better demonstrate the true degree of displacement compared to supine radiographs 1
• Clavicle fractures are typically classified by location: middle third (most common), distal third, and proximal third 2
• Assessment should include evaluation of displacement, comminution, and shortening 3

Nonsurgical Management

• A sling is the preferred immobilization method for most acute clavicle fractures, rather than a figure-of-eight brace 1, 3
• Nonsurgical management is appropriate for non-displaced fractures 1
• Patients treated with a simple arm sling experience less pain compared to those treated with figure-of-eight bandages 4
• 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 1
• Full weight-bearing activities are typically allowed between 8-12 weeks, depending on radiographic evidence of healing and clinical examination 1

Surgical Indications

• Surgical treatment is indicated for:
  • Displaced midshaft fractures in adults with shortening exceeding 1.5cm 1
  • Displaced lateral fractures with disruption of the coracoclavicular ligament complex 1
  • Open fractures requiring debridement and stabilization 3
  • Polytrauma patients where early mobilization is critical 3

Surgical Options

• Plate fixation is a common surgical option, with manufacturer-contoured anatomic clavicle plates preferred due to lower rates of implant removal or deformation 1
• Anterior inferior plating may lead to lower implant removal rates compared with superior plating 1, 3
• Intramedullary nailing provides equivalent long-term clinical outcomes to plate fixation with similar complication rates 1, 3
• Plate fixation may be more beneficial in the presence of fracture comminution 3

Special Considerations for Different Age Groups

• For adolescents (18 years and younger), nonsurgical management is generally preferred as the primary treatment approach for midshaft clavicular fractures 3
• Surgical treatment in adolescents has not demonstrated significant benefits over conservative management and is associated with high rates of subsequent surgeries for hardware removal 3

Rehabilitation

• Rehabilitation should include muscle strengthening exercises and long-term continuation of appropriate exercises 1
• Patient education about pain management strategies and monitoring for signs of complications requiring medical attention is important 1

Potential Complications

• Nonsurgical treatment of widely displaced fractures may result in higher nonunion rates, symptomatic malunion affecting shoulder strength and function, cosmetic concerns, and longer time to return to work 1
• Surgical complications may include need for hardware removal, particularly with non-precontoured plates 1
• Smoking increases the rate of nonunion in clavicle fractures and leads to inferior clinical outcomes 1

Treatment Algorithm

1. Assess fracture characteristics (location, displacement, comminution, shortening) 3
2. For non-displaced fractures: Use sling immobilization 1
3. For displaced midshaft fractures with >1.5cm shortening: Consider surgical fixation 1
4. For displaced lateral fractures with coracoclavicular ligament disruption: Consider surgical fixation 1
5. For adolescents: Prefer nonsurgical management unless absolute surgical indications exist 3
6. Monitor healing with follow-up radiographs and progress to rehabilitation as healing occurs 1, 3