Treatment of Undisplaced Non-Comminuted Clavicle Fracture in a 12-Year-Old Male
Treat this fracture conservatively with a sling for immobilization—surgery is not indicated for undisplaced fractures in adolescents and nonsurgical management provides excellent outcomes in this age group. 1, 2
Primary Treatment Approach
Conservative management is the definitive treatment for this patient. The American Academy of Orthopaedic Surgeons specifically recommends nonsurgical management for non-displaced fractures, citing its effectiveness 1. For adolescents 18 years and younger, nonsurgical management is the preferred primary treatment approach for midshaft clavicular fractures 2.
Immobilization Method
- Use a simple sling rather than a figure-of-eight brace as the preferred immobilization method for acute clavicle fractures 1, 2
- The sling is better tolerated and provides adequate support for healing 1
- Continue sling use for comfort, typically 2-4 weeks depending on pain levels 1
Why Surgery is NOT Indicated
This patient has none of the absolute indications for surgical intervention in adolescents, which include 2:
- Open fractures requiring debridement
- Polytrauma requiring early mobilization
- Severely displaced fractures with >1.5cm shortening
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. Long-term functional outcomes are typically excellent with nonsurgical management in the adolescent population 2.
Clinical Monitoring
- Obtain upright radiographs for proper assessment, as they better demonstrate the true degree of displacement compared to supine films 1, 2
- Schedule orthopedic follow-up to monitor healing progress with repeat radiographs 2
- Urgent orthopedic referral is only needed if displacement exceeds 100% (no cortical contact between fragments), which is not the case here 1
Expected Outcomes
- Nondisplaced or minimally displaced fractures can be managed successfully without surgery 1
- The nonunion rate for undisplaced midshaft fractures treated conservatively is very low 3
- Adolescents have large healing potential, particularly for physeal and metaphyseal injuries 4
Common Pitfall to Avoid
Do not use low-intensity pulsed ultrasonography (LIPUS) for nonsurgical management, as it does not accelerate healing or reduce nonunion rates 1.