From the Guidelines
Surgery for a displaced clavicle fracture should be considered within 1-2 weeks of the injury to optimize outcomes and minimize complications. This recommendation is based on the most recent and highest quality study available, which suggests that surgical treatment of displaced clavicle fractures results in equivalent or improved short-term patient-reported outcomes and reduced rates of nonunion or symptomatic malunion when compared with nonsurgical treatment 1. The American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures highlights the importance of early surgical intervention for widely displaced fractures to prevent malunions and adverse effects on strength and function of the shoulder 1.
Key considerations for surgical intervention include:
- Degree of displacement (typically greater than 1.5-2 cm displacement or 100% displacement)
- Shortening of more than 1.5-2 cm
- Significant comminution (multiple fragments) Prior to surgery, patients should manage pain with appropriate analgesics, apply ice, and keep the arm immobilized in a sling. Delaying surgery beyond 2-3 weeks can make the procedure more technically challenging as the bone begins to form callus and early healing occurs. Early surgical fixation for significantly displaced fractures can lead to better functional outcomes, decreased risk of malunion, and potentially faster return to activities compared to conservative management in certain cases, as supported by multiple randomized controlled trials comparing surgical with nonsurgical treatment of displaced clavicle fractures 1.
From the Research
Timing of Surgery for Displaced Clavicle Fractures
- The optimal timing for surgery after a displaced clavicle fracture is a crucial factor in determining the outcome of the treatment 2.
- A study published in 2019 found that delaying surgery beyond 96 days from the time of injury increases the risk of major complications and revision surgery 2.
- The same study suggested that a delay of up to three months following injury may be acceptable, but beyond this period, the risk of complications and revision surgery increases 2.
- Another study published in 2017 described the surgical technique for open reduction and internal fixation of middle-third clavicle fractures, but did not specifically address the timing of surgery 3.
- Other studies have compared conservative management with open reduction and internal fixation for mid-shaft clavicle fractures, but the timing of surgery was not the primary focus of these studies 4, 5, 6.
Considerations for Surgery
- The decision to operate on a displaced clavicle fracture should be based on individual patient factors, including the severity of the fracture, the patient's age and activity level, and the presence of any comorbidities 5, 6.
- Operative treatment has been shown to produce superior results compared with conservative management in recent trials of management of displaced fractures 5.
- A treatment algorithm that takes into account the anatomical location of the fracture, as well as the patient's individual characteristics, can help guide the decision-making process 6.