Treatment

Healing of a fractured clavicle is often rapid:

• 6 weeks in an adult but with return of function within 3 weeks
• 3 weeks in a child

Traditionally most are treated non-operatively and even in displaced fractures, a high rate of good results with a low non-union rate has been reported (1).

Greenstick injuries require very minimal support.

Operative reduction however, may be indicated in a severely displaced outer one-third fracture. The fracture is held with a pin. A sling should be warn for 6 weeks and active movement encouraged once removed. Untreated, these fractures may cause marked deformity and less commonly, shoulder weakness.

Treatment of clavicle fractures depends on the fracture classification:

• group I (midshaft)
  • managed non-operatively whether displaced or non-displaced
  • immobilization in a sling or figure-of-eight dressing for one to two weeks or until the major pain subsides (depending on the patient’s comfort level.).
    • although figure-of-eight dressing was originally thought to improve alignment, several studies have reported similar union rates and increased satisfaction in patients treated with a simple arm sling (3)
  • it is important that:
    • active shoulder exercises are performed once the pain subsides
    • the sling does not rub against the fracture
• group II (distal)
  • non displaced and minimally displaced fractures have low rates of non-union hence the treatment of choice is non-operative, in a simple sling and early range-of-motion exercises as pain allows
  • displaced fractures tend to have a high rate of non union and a primary operative intervention may be required (2)
• group III (proximal)
  • non displaced fractures - immobilisation in a sling or figure-of-eight dressing is all that is required
  • displaced fractures - surgery may be required (3)

Note:

• although non-operative method is preferred in clavicular fractures irrespective of the displacement, some recent studies have suggested that long term results are not as favourable as previously considered

Reference:

• (1) Faldini C et al. Nonoperative treatment of closed displaced midshaft clavicle fractures. J Orthop Traumatol. 2010;11(4):229-36
• (2) Toogood P et al. Clavicle fractures: a review of the literature and update on treatment. Phys Sportsmed. 2011;39(3):142-50.
• (3) Pecci M, Kreher JB. Clavicle fractures. Am Fam Physician. 2008;77(1):65-70.