From the Guidelines
Surgical treatment is not typically recommended for an incomplete fracture of the mid left clavicle with 20 degree superior apex angulation, as conservative management is often sufficient for such cases with minimal displacement. The approach to treating this type of fracture involves non-surgical management, focusing on pain relief and supporting the natural healing process of the bone. According to the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1, many clavicle fractures can be managed successfully without surgery, especially those with minimal displacement. Key aspects of conservative treatment include:
- Use of a figure-of-eight brace or a simple arm sling for 4-6 weeks to immobilize the fracture site
- Pain management using NSAIDs such as ibuprofen 400-600mg every 6-8 hours or acetaminophen 500-1000mg every 6 hours as needed
- Activity modification to avoid heavy lifting and contact sports until healing is confirmed
- Ice application for 15-20 minutes several times daily during the first few days to reduce pain and swelling
- Follow-up radiographs at 2 weeks and 6 weeks to assess healing progress
- Physical therapy after 4-6 weeks to restore range of motion and strength This approach is supported by the fact that incomplete clavicle fractures with angulation less than 30 degrees typically heal well without surgical intervention, due to the clavicle's excellent blood supply and healing potential 1.
From the Research
Treatment Options for Incomplete Fracture of Mid Left Clavicle with 20 Degree Superior Apex Angulation
- The treatment for an incomplete fracture of the mid left clavicle with 20 degree superior apex angulation can be either conservative or surgical, depending on the severity of the fracture and the patient's overall health 2, 3, 4, 5, 6.
- Conservative treatment typically involves immobilization in a sling for 6 weeks or until clinical or radiological union is achieved 3, 4.
- Surgical treatment, such as open reduction and internal fixation, may be considered for displaced fractures, especially in young and active patients, as it has shown superior results compared to conservative management in recent trials 4, 6.
- The decision to opt for surgical or conservative treatment should be made on an individual patient basis, taking into account the relative benefits and harms of each intervention, as well as patient preferences 5.
Comparison of Conservative and Surgical Treatment
- Studies have shown that surgical treatment may reduce the risk of treatment failure, such as non-union or malunion, compared to conservative treatment 4, 5.
- However, surgical treatment may also result in adverse outcomes, such as infection, dehiscence, or hardware irritation 5.
- Conservative treatment, on the other hand, may result in a higher risk of symptomatic malunion or shoulder stiffness 5.
- The quality of life and functional outcomes may not differ significantly between surgical and conservative treatment 5.
Considerations for Treatment
- The patient's age, activity level, and overall health should be taken into account when deciding on a treatment plan 2, 6.
- The severity of the fracture, including the degree of displacement and angulation, should also be considered 3, 4.
- A thorough discussion of the potential benefits and risks of each treatment option should be had with the patient to ensure an informed decision is made 5.