Healing Time for Clavicle Fractures
Most clavicle fractures heal within 6-12 weeks with nonoperative management, though clinical recovery and radiographic union follow different timelines.
Expected Healing Timeline
Early Phase (0-6 Weeks)
- Callus formation typically begins by 2-4 weeks after injury, representing the earliest radiographic sign of healing 1
- Pain should decrease significantly during this period—patients who show minimal pain improvement between weeks 2 and 4 are at substantially higher risk (18-fold) of developing symptomatic nonunion 2
- By 6 weeks, approximately 69% of patients with displaced fractures will have QuickDASH scores below 40 points, and 95% of these patients will achieve union 1
Union Phase (6-12 Weeks)
- Radiographic union is typically confirmed at 6 months on CT imaging, which is the gold standard for assessing healing 1
- The nonunion rate with nonoperative treatment ranges from 7% overall 3 to 14% for displaced midshaft fractures 1
- Displaced fractures (>1 bone width displacement) have significantly higher rates of persistent symptoms and nonunion 3
Age-Specific Considerations
Neonatal Fractures
- Birth-related clavicle fractures heal spontaneously within 2-4 weeks without intervention 4
- These fractures require only parental reassurance and pain management—no sling is necessary 4
- Healing occurs without residual deformity in the vast majority of cases 4
Pediatric Fractures
- Children develop prominent callus formation that may concern parents but represents normal healing 5
- Healing is generally faster than in adults due to robust periosteal response 5
Factors Affecting Healing Time
Risk Factors for Delayed Union or Nonunion
- Displacement >1 bone width is the strongest predictor of complications 3
- Smoking increases nonunion rates and leads to inferior clinical outcomes 6
- Comminuted fractures and higher age are associated with increased risk of persistent symptoms at 6 months 3
- Absence of callus on radiographs at 6 weeks strongly predicts nonunion (60% risk when combined with other factors) 1
Surgical Treatment Timeline
- Surgical fixation allows for faster return to function, with athletes returning to outdoor training by 4 weeks (93% of cyclists) and competition by 6 weeks (56%) 7
- Full weight-bearing activities after surgical fixation are typically allowed between 8-12 weeks depending on radiographic healing 6
- Sling use after surgery can be discontinued by 4 weeks for routine activities 6
Clinical Decision Points
6-Week Assessment Is Critical
- Patients should be reassessed at 6 weeks to predict healing trajectory 1
- Red flags at 6 weeks include: QuickDASH score ≥40 points, no visible callus on radiographs, and fracture movement on examination 1
- If none of these red flags are present (40% of patients), the nonunion risk is only 3% 1
- If ≥2 red flags are present (23.5% of patients), the nonunion risk jumps to 60%, warranting surgical consultation 1
Pain as a Prognostic Indicator
- Minimal pain decrease between weeks 2 and 4 (VAS ratio >0.6) indicates high nonunion risk and should prompt consideration of surgical intervention 2
- This simple clinical assessment may be more accurate than baseline radiographic factors alone 2
Common Pitfalls
- Do not rely solely on initial radiographs to predict healing—the 6-week assessment provides superior prognostic information (87.3% accuracy vs 64.8% at time of injury) 1
- Do not dismiss persistent pain at 4 weeks—this is a critical warning sign requiring closer monitoring or surgical referral 2
- Do not assume all fractures heal equally—displaced fractures have a 42% rate of persistent sequelae at 6 months with nonoperative treatment 3