What is the appropriate management for a non-displaced midclavicular fracture?

Management of Non-Displaced Midclavicular Fracture in an Adolescent

For this 14-year-old with a non-displaced midclavicular fracture, treat conservatively with a sling for comfort, immediate pain control, and early range-of-motion exercises—surgery offers no benefit and carries unnecessary risks in adolescents with displaced fractures, let alone non-displaced ones. 1

Immediate Management

Pain Control

• Provide appropriate analgesics immediately, including acetaminophen, NSAIDs, or opioids if pain is severe 2
• Pain relief should be initiated before starting any rehabilitation activities 1

Immobilization

• Use a simple sling for comfort rather than a figure-of-eight brace 1
• The sling can be discarded as early as the patient's pain allows and is used for comfort only 2
• The figure-of-eight brace is not preferred based on expert opinion from the American Academy of Orthopaedic Surgeons 1

Early Rehabilitation

Range of Motion

• Begin early finger and hand motion immediately 3
• Start gentle range-of-motion exercises for the shoulder, elbow, wrist, and hand within the first few days once pain is controlled 2
• Restrict above-chest level activities until fracture healing is evident 3, 2

Progressive Activity

• Introduce early physical training and muscle strengthening once initial pain subsides 2
• Most patients with isolated clavicle fractures show nearly normal range of motion within 1 week after injury 4

Why Surgery is Not Indicated

Evidence Against Surgery in Adolescents

• In adolescent patients (≤18 years) with displaced midshaft clavicle fractures, surgical treatment offers no benefit compared with nonsurgical treatment 1
• Surgery is associated with similar union rates but substantial revision surgery rates for implant removal in this age group 1
• Since this fracture is non-displaced, the case for conservative management is even stronger than for displaced fractures 5

Expected Outcomes with Conservative Treatment

• Non-displaced or minimally displaced midshaft fractures have very low nonunion rates with conservative treatment 5
• All conservatively treated fractures in similar cases heal clinically and radiologically within 6 weeks 4

Follow-Up and Monitoring

Clinical Assessment

• Monitor for increasing pain, swelling, or loss of function that might indicate displacement or complications 2
• Regular assessment of healing progress and functional improvement is necessary 2

Red Flags Requiring Urgent Reassessment

• Development of neurovascular compromise 2
• Severe uncontrolled pain 2
• Signs of compartment syndrome 2
• Inability to participate in basic activities of daily living due to mechanical block 2

Common Pitfalls to Avoid

• Do not over-immobilize: Prolonged immobilization leads to stiffness and delayed functional recovery 3
• Do not use figure-of-eight braces: These are less comfortable and offer no advantage over a simple sling 1
• Do not consider surgery for non-displaced fractures in adolescents: The risks outweigh any theoretical benefits, especially given the high implant removal rates 1
• Do not delay early motion: Early introduction of range-of-motion exercises is critical for optimal functional outcomes 3, 2