Primary Care Management of Clavicle Fractures
For most acute clavicle fractures, a sling is the preferred immobilization method rather than a figure-of-eight brace, with nonsurgical management being appropriate for non-displaced fractures. 1
Initial Assessment and Diagnosis
- Upright radiographs are recommended for proper assessment as they better demonstrate the true degree of displacement compared to supine radiographs 1, 2
- Clavicle fractures are classified into three groups: midshaft (most common), lateral, and medial fractures 3
- Evaluate for associated injuries, particularly neurovascular compromise, which may require emergent referral 4
Treatment Algorithm
Nonsurgical Management (First-line for most fractures)
- Use a simple sling for immobilization in non-displaced or minimally displaced fractures 1, 4
- Sling use can typically be discontinued by 4 weeks for routine activities 1
- Weight-bearing restrictions should continue until 8-12 weeks, depending on radiographic healing 1
- Low-intensity pulsed ultrasonography (LIPUS) should not be used as it does not accelerate healing or reduce nonunion rates 1
Surgical Referral Indications
- Displaced midshaft fractures with shortening exceeding 1.5cm 1, 2
- Displaced lateral fractures with disruption of the coracoclavicular ligament complex 1
- Open fractures requiring debridement and stabilization 2, 4
- Polytrauma patients where early mobilization is critical 2
- Fractures with significant displacement (>100%) 4
Special Considerations
Age-Specific Management
- For adolescents (≤18 years), nonsurgical management is generally preferred as the primary treatment approach 2
- Surgical treatment in adolescents has not demonstrated significant benefits over conservative management and is associated with high rates of subsequent surgeries for hardware removal 2
Complications to Monitor
- Smoking increases nonunion rates and leads to inferior clinical outcomes 1
- Nonsurgical treatment of widely displaced fractures may result in higher nonunion rates and symptomatic malunion affecting shoulder strength and function 1
- Patients with primary displacement >15mm or shortening may experience more pain during recovery 5
Rehabilitation Protocol
- Begin muscle strengthening exercises after initial healing period 1
- Avoid lifting, pushing, or pulling with the affected arm for at least 4 weeks 1
- Full weight-bearing activities are typically allowed between 8-12 weeks, based on radiographic healing and clinical examination 1
Follow-up Care
- Monitor healing progress with follow-up radiographs 2
- Evaluate for potential complications such as nonunion or malunion, which may require surgical intervention if symptomatic 3
- Long-term patient-reported outcomes and satisfaction are similar between surgical and nonsurgical approaches for most fractures 1