From the Guidelines
Surgical treatment is recommended for distal clavicle fractures, especially those with significant displacement, to reduce the risk of nonunion and symptomatic malunion, and to improve functional outcomes and patient satisfaction. This is based on recent evidence from the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1. The guideline 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.
For stable, non-displaced fractures, conservative management may be considered, including immobilization with a sling, which is preferred over a figure-of-eight brace 1. Pain control with NSAIDs or acetaminophen and gradual return to activities as pain allows can also be part of the conservative management plan. However, for displaced fractures, surgical options such as plate fixation, hook plates, or coracoclavicular stabilization using screws or suture techniques may be necessary to restore anatomical alignment and stability.
Key considerations in the decision between conservative and surgical management include:
- Patient's age and activity level
- Degree of displacement and associated soft tissue injuries
- Potential risks and benefits of each treatment approach
- Impact on functional outcomes and patient satisfaction
Recovery after surgery typically involves wearing a sling for 2-4 weeks, followed by progressive rehabilitation for 3-6 months. Complications to watch for include nonunion, malunion, hardware irritation, and shoulder stiffness. Overall, the goal of treatment is to achieve optimal functional outcomes, minimize complications, and improve patient satisfaction, with surgical treatment being a preferred option for displaced distal clavicle fractures 1.
From the Research
Treatment Options for Distal Clavicle Fractures
- Surgical fixation is often recommended for displaced distal clavicle fractures, particularly type II fracture patterns, due to their high rates of nonunion with nonoperative management 2
- Hook plate fixation has demonstrated reliably high rates of osseous union with good functional outcomes 2
- Open reduction internal fixation with supplementary button coracoclavicular fixation is another technique used to achieve both plate and coracoclavicular stabilization 3
Classification and Treatment Approach
- There is no consensus on the best classification system or the ideal treatment approach for distal clavicle fractures, with numerous treatment options available 4
- Each surgical technique has its pros and cons, and a gold standard treatment has not yet been established 4
- The treatment approach may depend on the fracture pattern, degree of displacement, and patient factors such as age and activity level 5, 6
Indications for Operative Treatment
- Operative treatment is often discussed with patients with displaced clavicle fractures, especially in young and active patients 5
- Emergent referral is indicated for open fractures, posteriorly displaced proximal fractures, and those with emergent associated injuries 6
- Urgent referral is warranted for fractures with greater than 100% displacement, fractures with >2 cm of shortening, comminuted fractures, unstable distal fractures, and floating shoulder 6