Is a shoulder immobilizer and orthopedic follow-up appropriate for a stable adult patient with a displaced fracture of the distal end of the right clavicle, shortening, and inferior displacement of the distal fracture fragment, but no dislocation, after a fall?

Management of Displaced Distal Clavicle Fracture

Your plan to place a shoulder immobilizer and arrange orthopedic follow-up tomorrow is appropriate for this displaced distal clavicle fracture without dislocation. 1

Initial Emergency Department Management

Immobilization Strategy

• Apply a shoulder immobilizer (sling) immediately for comfort and fracture stabilization 1, 2
• Shoulder immobilizers are the standard first-line treatment for clavicle fractures in the emergency setting, providing adequate support while minimizing patient discomfort 1
• Avoid rigid casting or complex immobilization devices in the ED—simple sling immobilization is sufficient for initial management 2

Pain Control

• Implement multimodal analgesia including NSAIDs and consider short-term opioid prescription (3-5 days maximum) for acute pain management 1
• Ice application and activity modification should be emphasized 1

Orthopedic Referral Timing

Next-Day Follow-Up is Appropriate

Your plan for next-day orthopedic evaluation is correct because:

• No emergent surgical indications are present (no open fracture, no neurovascular compromise, no posteriorly displaced fragments) 1
• The fracture description indicates displacement and shortening but does NOT meet criteria for emergent consultation 1

When Emergent (Same-Day) Consultation Would Be Required

You would need immediate orthopedic consultation only if: 1

• Open fracture
• Neurovascular compromise
• Posteriorly displaced proximal clavicle fractures (not applicable here—this is distal)
• Associated emergent injuries

Urgent (24-48 Hour) Referral Indications

Your case falls into this category, which is appropriate for next-day follow-up: 1

• Displacement with shortening (as described in your X-ray)
• Distal clavicle fractures with instability potential
• Fractures requiring surgical consideration but without emergent indications 1, 2

Distal Clavicle Fracture Considerations

Classification Matters for Treatment

• Distal clavicle fractures are classified based on relationship to coracoclavicular ligaments 3
• Type I (lateral to ligaments): Stable, typically non-operative 3
• Type II (medial to ligaments): Unstable, often require surgical fixation 3
• Your X-ray states "no dislocation," which is reassuring, but the orthopedic surgeon will need to determine ligament integrity and fracture stability 3

Why Orthopedic Evaluation is Essential

• Distal clavicle fractures have higher rates of nonunion compared to midshaft fractures when unstable 2
• The presence of "shortening and inferior displacement" suggests potential instability that may require surgical intervention 3, 2
• Orthopedics will determine if this is a stable Type I or unstable Type II fracture pattern, which fundamentally changes management 3

Critical Pitfalls to Avoid

Do Not Assume All Clavicle Fractures Are Non-Operative

• While midshaft clavicle fractures are often managed conservatively, distal clavicle fractures with displacement and shortening frequently require surgical fixation 3, 2
• Recent evidence shows that displaced fractures with shortening have higher rates of symptomatic nonunion or malunion when treated non-operatively 2

Ensure Adequate Imaging Review

• Confirm that standard radiographs adequately visualize the distal clavicle and acromioclavicular joint 4
• The orthopedic surgeon may order additional views or CT imaging to better characterize the fracture pattern and assess coracoclavicular ligament integrity 2

Patient Education Before Discharge

• Explain that while initial treatment is non-operative, surgical fixation may ultimately be recommended based on fracture stability assessment 3, 2
• Instruct the patient to keep the arm immobilized and avoid lifting or reaching until orthopedic evaluation 1
• Provide clear return precautions for neurovascular symptoms (numbness, tingling, weakness, color changes) 1

Summary of Your Appropriate Plan

Your management is correct: shoulder immobilizer placement with next-day orthopedic follow-up is the appropriate ED disposition for this displaced distal clavicle fracture without emergent indications 1. The orthopedic surgeon will determine definitive management (operative vs. non-operative) based on fracture stability, patient factors, and functional demands 3, 2.

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