Treatment of Midclavicular Non-Displaced Fractures
Non-displaced midclavicular fractures should be managed nonsurgically with sling immobilization, which is the preferred method over figure-of-eight bracing. 1
Primary Treatment Approach
- Immobilization with a sling is the definitive treatment for non-displaced midclavicular fractures, as recommended by the American Academy of Orthopaedic Surgeons. 1
- The sling is specifically preferred over figure-of-eight bracing for acute clavicle fractures, as it provides adequate immobilization with better patient comfort. 1
- Nonsurgical management is highly effective for non-displaced fractures, with very low nonunion rates documented in this fracture pattern. 1, 2
Initial Assessment
- Obtain upright radiographs rather than supine films, as they better demonstrate the true degree of displacement and confirm the non-displaced nature of the fracture. 1
- Assess for any associated injuries, particularly in trauma settings where scapular or rib fractures may coexist. 3
Duration of Immobilization
- Most patients can discontinue sling use for routine activities by 4 weeks, though they should continue avoiding lifting, pushing, or pulling with the affected arm. 1
- Full weight-bearing activities are typically permitted between 8-12 weeks, based on radiographic healing and clinical examination. 1
What NOT to Do
- Do not use low-intensity pulsed ultrasonography (LIPUS) for treatment, as it does not accelerate healing or reduce nonunion rates in midshaft clavicle fractures. 1
- Avoid figure-of-eight bracing as the primary immobilization method, as slings are now the preferred standard. 1
Important Counseling Points
- Smoking significantly increases nonunion risk and leads to inferior clinical outcomes, so smoking cessation should be strongly encouraged. 1
- Non-displaced fractures have excellent prognosis with conservative management, with union rates approaching 100%. 2, 4
- Patients should be educated about pain management strategies and signs of complications requiring medical attention. 1
Rehabilitation Protocol
- Initiate muscle strengthening exercises as tolerated after the initial immobilization period. 1
- Long-term continuation of appropriate shoulder exercises is essential for optimal recovery. 1
- Monitor for any signs of complications such as persistent pain, deformity, or functional limitations that might indicate nonunion or malunion. 1
When Surgery Is NOT Indicated
- Non-displaced fractures do not meet surgical criteria, which are reserved for displaced midshaft fractures with shortening exceeding 1.5cm or displaced lateral fractures with coracoclavicular ligament disruption. 1
- Even in adolescents, nonsurgical management remains the preferred approach for non-displaced fractures. 5