Initial Management of Pediatric Clavicle Fractures
For pediatric clavicle fractures, immobilize with a simple sling and manage nonoperatively—this is the preferred approach for the vast majority of cases regardless of displacement, as children have excellent healing potential and functional outcomes are consistently good with conservative treatment. 1, 2
Immediate Assessment and Immobilization
Initial Evaluation
- Obtain upright radiographs (anteroposterior and panoramic views of both shoulders) to assess displacement, as these better demonstrate true displacement compared to supine films 1, 2
- Examine for associated injuries including neurovascular compromise, skin integrity (open fracture), and soft tissue complications 2, 3
- Check for posterior displacement through the trapezius muscle, which creates obvious deformity and requires reduction 4
Immobilization Method
- Apply a simple sling as the primary immobilization device—this is superior to figure-of-eight bracing 1, 2
- Continue sling use for comfort, typically 2-4 weeks depending on pain resolution 5, 6
- Begin gentle range of motion exercises as pain allows 3
Age-Specific Considerations
Children Under 9 Years (Girls) or 12 Years (Boys)
- Treat virtually all fractures nonoperatively regardless of displacement or shortening 6, 7
- Even relative shortening of 9.5-28% heals with excellent functional outcomes and no symptomatic malunion 7
- No pseudoarthrosis occurs in this age group with conservative management 7
Adolescents (9-12+ Years to 18 Years)
- Nonsurgical management remains the preferred primary treatment approach, as surgical intervention has not demonstrated significant benefits over conservative management and carries high rates of hardware removal procedures 2, 3
- Long-term functional and patient-reported outcomes are excellent with nonoperative treatment 2, 3
Indications for Urgent Orthopedic Consultation
Emergent Referral (Same Day)
- Open fractures requiring debridement and stabilization 2, 6
- Posteriorly displaced proximal fractures 6
- Fractures with neurovascular compromise 6, 3
- Polytrauma patients requiring early mobilization 2
Urgent Referral (Within Days)
- Displacement >100% with no cortical contact between fragments 1, 6
- Severely displaced fractures with shortening >1.5-2 cm that may affect functional outcomes 1, 2
- Comminuted fractures with significant instability 6
- Posteriorly displaced distal metaphyseal fractures with bone entrapped through trapezius muscle 4
- Floating shoulder injuries 6
Common Pitfalls to Avoid
- Do not use figure-of-eight bracing—slings are preferred and more comfortable 1, 2
- Do not apply adult surgical indications to pediatric patients—children tolerate much greater displacement and shortening without functional consequences 7
- Do not use low-intensity pulsed ultrasonography (LIPUS), as it does not accelerate healing or reduce nonunion rates 1
- Do not obtain only supine radiographs, as they underestimate true displacement 1, 2
Expected Outcomes with Conservative Management
- Healing occurs uneventfully in the vast majority of cases 5, 3
- No increased risk of pseudoarthrosis or symptomatic malunion in the pediatric population 7
- Functional outcomes and patient satisfaction are excellent regardless of initial displacement 3, 7
- Rehabilitation period correlates with age and degree of shortening, but ultimate outcomes remain good 7