What are the discharge instructions and follow-up care with a primary care physician (PCP) for a child with a clavicular fracture?

Pediatric Clavicular Fracture Discharge Instructions and Follow-Up

Most pediatric clavicular fractures can be safely discharged from the emergency department with simple sling immobilization and follow-up with the primary care physician within 1-2 weeks, as these fractures typically heal with minimal intervention and have excellent outcomes. 1, 2

Immediate Discharge Management

Immobilization

• Provide a simple arm sling for comfort and support 2, 3
• No rigid casting or figure-of-eight bandages are necessary for most midshaft clavicle fractures 1
• The sling should be worn for comfort, typically 2-4 weeks depending on symptoms 4

Pain Control

• Implement multimodal analgesia with acetaminophen and/or ibuprofen for pain management 2
• Prescribe appropriate weight-based dosing for pediatric patients
• Pain typically improves significantly within the first week 4

Critical Discharge Instructions for Families

Activity Restrictions

• Avoid contact sports and vigorous physical activity until cleared by the primary care physician 4
• Limit arm movement to activities of daily living during the first 2-3 weeks 3
• No heavy lifting or overhead activities until fracture healing is confirmed 4

Expected Healing Process

• Reassure parents that a prominent callus (bump) will form at the fracture site during healing—this is normal and expected in children 4
• The callus typically remodels over 6-12 months, though some prominence may persist 4
• Most pediatric clavicle fractures heal within 3-6 weeks 1, 4

Warning Signs Requiring Immediate Return

• Increasing pain, swelling, or redness at the fracture site
• Numbness, tingling, or weakness in the arm or hand
• Skin changes suggesting vascular compromise
• Fever or signs of infection

Follow-Up Care with Primary Care Physician

Timing of Follow-Up

• Schedule follow-up appointment with PCP within 1-2 weeks of discharge 1, 2
• Earlier follow-up (within 3-5 days) may be warranted for displaced fractures or younger children 5

What the PCP Should Monitor

• Clinical healing: decreased pain, improved range of motion, and return to function 4
• Radiographic healing is typically not necessary unless clinical concerns arise 1
• Assessment for complications, though these occur in only 2.5% of conservatively treated pediatric cases 5

Age-Specific Considerations

Infants and Young Children (<24 months)

• Important caveat: For children under 24 months with clavicle fractures and no clear history of trauma, consider skeletal survey to evaluate for non-accidental trauma 6
• Skeletal survey is necessary in children 1-11 months old with clavicle fractures and no history of trauma 6
• For children 12-23 months old with a clear history of a fall, skeletal survey is not necessary 6

Older Children and Adolescents

• Each year of age past infancy increases complication risk by 18.1% 5
• Adolescents (girls >9 years, boys >12 years) should be managed using algorithms similar to adults 2
• These patients may require more thorough follow-up, particularly if the fracture is completely displaced 5

Indications for Urgent Orthopedic Referral (Not PCP Follow-Up)

The following scenarios require urgent orthopedic consultation rather than routine PCP follow-up:

• Fractures with >100% displacement 2
• Fractures with >2 cm of shortening 2
• Comminuted fractures 2
• Unstable distal clavicle fractures 2
• Open fractures (emergent referral) 2
• Associated neurovascular injury 2

Common Pitfalls to Avoid

• Do not assume all clavicle fractures in infants are birth injuries—consider non-accidental trauma if no clear birth history or if the child is beyond the neonatal period 6, 4
• Completely displaced fractures have 3.2 times higher odds of complications and warrant closer follow-up 5
• Avoid over-immobilization with rigid devices, as simple sling support is sufficient for most pediatric cases 1, 2