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Fracture of clavicle — Clinical Guidelines

Overview

Clavicle fractures are common long bone injuries, often resulting from direct trauma or falls. Midshaft fractures constitute approximately 80% of all clavicle fractures and are frequently managed nonoperatively, though surgical intervention may be indicated for displaced fractures or complications like nonunion 12.

Diagnosis

Clinical Presentation: Localized pain, swelling, and crepitus over the clavicle 13.

Radiographic Evaluation: X-rays are standard for diagnosis, assessing fracture pattern, displacement, and shortening 7 9.

Computed Tomography (CT): Recommended for detailed assessment of complex fractures and shortening 7.

Grading: Classification systems like the AO/OTA classification help guide management decisions 8.

Management

Conservative Treatment: Arm sling or figure-of-eight bandage for non-displaced or minimally displaced fractures 12.

Kinesiotaping: Adjunctive therapy to reduce pain and potentially improve outcomes in conservative management 5.

Surgical Intervention: Indicated for displaced fractures with >2 cm shortening, open reduction and internal fixation (ORIF) using plates or intramedullary nailing 11 12.

Smoking Consideration: Smokers have a higher risk of nonunion; smoking cessation advised 3.

Special Populations

Pediatrics: Clavicle fractures are common in children; immobilization with a sling or brace is typically sufficient 13.

Elderly: Increased risk of complications like nonunion; careful monitoring and possibly earlier surgical intervention if conservative treatment fails 12.

Comorbidities: Smoking negatively impacts healing; patients should be advised on cessation strategies 3.

Key Recommendations

Use CT for detailed assessment of clavicle fractures with suspected shortening or complex patterns (Evidence: Moderate 7).

Consider surgical intervention for displaced midshaft clavicle fractures with >2 cm shortening (Evidence: Moderate 12 9).

Implement kinesiotaping as an adjunct to conservative treatment to potentially improve clinical outcomes (Evidence: Weak 5).

Advise smoking cessation in patients with clavicle fractures due to increased risk of nonunion (Evidence: Moderate 3).

Monitor pediatric clavicle fractures closely with immobilization; surgical intervention is rarely needed (Evidence: Expert opinion 13).

References

1 Labandeyra H, Heredia C, Váldes-Vilches LF, Prats-Galino A, Sala-Blanch X. Clavipectoral fascia plane block in midshaft clavicle fractures: A cadaveric study. Journal of clinical anesthesia 2024. link 2 Ejlersen M. The human clavicle's nutrient foramen's prevalence, number, location, and direction: A systematic review and meta-analysis. The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 2023. link 3 Dietrich G, Terrier A, Favre M, Elmers J, Stockton L, Soppelsa D et al.. Influence of smoking on the healing of conservatively treated displaced midshaft clavicle fractures. The bone & joint journal 2023. link 4 Sanchez PH, Fleury IG, Parker EA, Davison J, Westermann R, Kopp B et al.. Early Versus Delayed Surgery for Midshaft Clavicle Fractures: A Systematic Review. The Iowa orthopaedic journal 2023. link 5 Dedeoglu SS, Imren Y, Karslioglu B, Keskin A, Atar S, Bilsel K. Kinesiotaping therapy for midshaft clavicular fractures: a randomised trial study. Acta orthopaedica Belgica 2022. link 6 Mohapatra A, Arora Y, Choudhury P, Jangir R. Segmental Fracture Of The Clavicle - Unconventional Fracture Pattern Of A Conventionally Fractured Bone: A Case Report With Review Of Literature. Journal of Ayub Medical College, Abbottabad : JAMC 2022. link 7 Lima GV, La Banca V, Murachovsky J, Nascimento LGP, Almeida LHO, Ikemoto RY. Assessment of the measurement methods in midshaft clavicle fracture. BMC musculoskeletal disorders 2022. link 8 Serpico M, Tomberg S. The emergency medicine management of clavicle fractures. The American journal of emergency medicine 2021. link 9 Thorsmark AH, Christensen OM, Torp-Pedersen S, Overgaard S, Frich LH. Changes in clavicle length in acute fractures within 3 weeks: a prospective ultrasonographic study of 59 patients. BMC musculoskeletal disorders 2017. link 10 Kim HN, Liu XN, Noh KC. Use of a real-size 3D-printed model as a preoperative and intraoperative tool for minimally invasive plating of comminuted midshaft clavicle fractures. Journal of orthopaedic surgery and research 2015. link 11 Braun KF, Siebenlist S, Sandmann GH, Martetschläger F, Kraus T, Schrödl C et al.. Functional results following titanium elastic-stable intramedullary nailing (ESIN) of mid-shaft clavicle fractures. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca 2014. link 12 McKee MD. Clavicle fractures in 2010: sling/swathe or open reduction and internal fixation?. The Orthopedic clinics of North America 2010. link 13 Shannon EG, Hart ES, Grottkau BE. Clavicle fractures in children: the essentials. Orthopedic nursing 2009. link 14 Quinn RH, Drenga J. Case reports: concurrent bilateral nontraumatic fractures of the clavicle. Clinical orthopaedics and related research 2006. link 15 Chez RA, Carlan S, Greenberg SL, Spellacy WN. Fractured clavicle is an unavoidable event. American journal of obstetrics and gynecology 1994. link90100-7) 16 Joseph PR, Rosenfeld W. Clavicular fractures in neonates. American journal of diseases of children (1960) 1990. link 17 Caspi I, Ezra E, Oliver S, Lin E, Lotan G, Horoszowski H. Treatment of avulsed clavicle and recurrent subluxations of the ipsilateral shoulder by dynamic fixation. The Journal of trauma 1987. link 18 Neviaser JS. Injuries of the clavicle and its articulations. The Orthopedic clinics of North America 1980. link 19 Ogden JA, Conlogue GJ, Bronson ML. Radiology of postnatal skeletal development. III. The clavicle. Skeletal radiology 1979. link

Fracture of clavicle