What is the recommended treatment for a clavicle (collarbone) fracture in a 2-year-old child?

Treatment of Clavicle Fracture in a 2-Year-Old Child

A clavicle fracture in a 2-year-old child should be treated with simple sling immobilization and does not require surgical intervention, but you must first determine if the fracture warrants a skeletal survey to evaluate for non-accidental trauma. 1

Initial Assessment for Non-Accidental Trauma

Before proceeding with fracture management, you must assess whether skeletal survey is indicated based on the mechanism of injury 1:

• If the fracture occurred from a reported fall: Skeletal survey is not necessary 1
• If there is no history of trauma or the fracture is attributed to being hit by a toy/object: Skeletal survey is necessary to evaluate for child abuse 1
• If there is blunt impact history: The appropriateness of skeletal survey is uncertain and requires clinical judgment 1

This is critical because clavicle fractures outside the neonatal period in children under 24 months raise concern for non-accidental trauma unless there is a clear fall history 1.

Fracture Management

Immobilization Method

Use a simple sling for immobilization rather than a figure-of-eight brace, as recommended by the American Academy of Orthopaedic Surgeons 2. This is the preferred method for acute clavicle fractures across all age groups 2.

Conservative Treatment Rationale

• Pediatric clavicle fractures heal uneventfully with nonoperative management 3
• The clavicle is the most commonly fractured long bone in children, and these fractures typically heal without complication 3, 4
• Surgical intervention is not indicated for simple clavicle fractures in this age group 5, 3

Pain Management

• Provide analgesic medications as needed 6
• In emergency department studies of children under 2 years, only 32% received analgesics in the ED and 51% were given prescriptions on discharge, though pain control should be addressed 6

Follow-Up and Expected Outcomes

• Primary care physicians can successfully manage simple clavicle fractures with excellent outcomes, similar to orthopedic surgeon management 4
• Bony union occurs reliably with conservative treatment 4
• No restrictions on activities of daily living are expected after healing 4

Red Flags Requiring Orthopedic Referral

While not typical in a 2-year-old, you should refer if 7:

• Open fracture
• Associated neurovascular injury
• Displacement greater than 100% (no cortical contact)
• Significant associated injuries

Common Pitfalls to Avoid

• Do not overlook the possibility of non-accidental trauma - always obtain a clear mechanism of injury 1
• Do not use figure-of-eight bracing - slings are preferred and better tolerated 2
• Do not routinely refer simple fractures to orthopedics - these are within the scope of primary care management 4