Does a 10-year-old child with a green stick clavicle fracture require a sling or shoulder immobilizer?

Treatment of Greenstick Clavicle Fractures in a 10-Year-Old

A simple sling is the preferred immobilization method for greenstick clavicle fractures in a 10-year-old child, as it provides equivalent healing outcomes to a figure-of-eight bandage while being more comfortable and practical for the patient. 1

Immobilization Method

• The American Academy of Orthopaedic Surgeons (AAOS) explicitly states that a sling is preferred in most cases for immobilization of acute clavicle fractures as opposed to a figure-of-eight brace. 1

• This recommendation applies to pediatric clavicle fractures, including greenstick fractures in school-age children like your 10-year-old patient. 1

• Multiple studies confirm no significant difference in radiological or clinical outcomes between sling and figure-of-eight bandage in pediatric clavicle fractures, with both methods showing excellent fracture healing, equivalent pain control, and similar muscle strength at follow-up. 2, 3

Why Sling Over Figure-of-Eight Bandage

• The sling is more comfortable and easier for children to tolerate, leading to better compliance with treatment. 2

• Figure-of-eight bandages can cause discomfort in the axilla and are more difficult to adjust properly, without providing superior healing outcomes. 2

• Both methods result in complete bony union with no complications in the pediatric age group. 2, 4

Expected Outcomes

• Greenstick and other simple clavicle fractures in children heal excellently with conservative management using a sling alone. 4

• Fracture healing typically occurs within 3-4 weeks, with clinical union evident at the first follow-up visit (approximately 24-25 days post-injury). 2

• Children return to full range of motion and normal muscle strength without long-term complications. 2, 5

Pain Management

• Implement multimodal analgesia with weight-based dosing of acetaminophen and/or ibuprofen for pain control. 6

• Pain typically resolves as healing progresses over the first few weeks. 2

Warning Signs Requiring Immediate Attention

• Skin changes suggesting vascular compromise, including numbness, tingling, or weakness in the arm or hand. 6

• Fever or signs of infection at the fracture site. 6

• Blue, purple, or pale discoloration of the extremity indicating poor perfusion. 1

Follow-Up

• Schedule first follow-up at approximately 3-4 weeks to confirm clinical healing. 2

• Discontinue sling use once fracture healing is confirmed and pain has resolved. 2

• This fracture can be managed entirely by primary care physicians without orthopedic referral, as outcomes are equivalent whether treated by orthopedics or primary care. 4

Common Pitfall to Avoid

• Do not feel compelled to use a figure-of-eight bandage based on outdated practice patterns—the evidence clearly shows no benefit over a simple sling, and the sling is more practical. 1, 2