treatment

Last reviewed 01/2018

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: