Initial Treatment for Teen with Clavicle Fracture
For a teen with a clavicle fracture, initiate nonsurgical management with a sling for immobilization, as this is the preferred first-line treatment for the vast majority of adolescent clavicle fractures. 1, 2
Primary Treatment Approach
- Use a sling rather than a figure-of-eight brace for immobilization, as recommended by the American Academy of Orthopaedic Surgeons for most acute clavicle fractures 1, 2
- Nonsurgical management is the preferred primary treatment for adolescents (18 years and younger) with midshaft clavicular fractures 2
- Brief sling immobilization followed by range of motion exercises constitutes the standard nonoperative protocol 3
Assessment Requirements
- Obtain upright radiographs to properly assess the degree of displacement, as these demonstrate true displacement better than supine films 1, 2
- Evaluate for specific fracture characteristics including displacement, shortening, and comminution 2
- Most clavicle fractures (80%) occur in the middle third of the bone 4
When to Consider Surgical Referral
Surgical intervention in adolescents should be reserved for specific absolute indications only, as surgery has not demonstrated significant benefits over conservative management and carries high rates of hardware removal procedures 2:
- Open fractures requiring debridement and stabilization 2
- Polytrauma patients where early mobilization is critical 2
- Severely displaced fractures with significant shortening exceeding 1.5cm that may affect functional outcomes 2
- Fractures with significant neurovascular compromise or soft tissue complications 3
Important Clinical Considerations
- Surgical treatment in adolescents is associated with high rates of subsequent surgeries for hardware removal, making conservative management preferable when no absolute indications exist 2
- Long-term functional outcomes are typically excellent with nonsurgical management in the adolescent population 2
- Studies demonstrate comparable mid- to long-term functional and patient-reported outcomes between operative and nonoperative management in pediatric patients 3
- Urgent orthopedic follow-up is recommended for fractures with displacement >100% (no cortical contact between fragments) 1
Common Pitfalls to Avoid
- Do not routinely pursue surgical management based solely on displacement, as adolescents heal well with conservative treatment unlike adults 2
- Avoid using figure-of-eight braces when a simple sling is more appropriate and comfortable 1, 2
- Do not use low-intensity pulsed ultrasonography (LIPUS) as it does not accelerate healing or reduce nonunion rates 1