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Clavicle fracture

What's new

Added 2023 AAOS and 2018 ACR guidelines for the diagnosis and management of clavicle fracture.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of clavicle fracture are prepared by our editorial team based on guidelines from the Surgical Infection Society Europe (SIS-E/GAIS/WSES/WSIS/AAST 2024), the American Academy of Orthopaedic Surgeons (AAOS 2023), the Eastern Association for the Surgery of Trauma (EAST/AOTA 2023), the American College of Radiology (ACR 2018), the British Medical Journal (BMJ 2017), ...
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Diagnostic investigations

X-ray: as per AAOS 2023 guidelines, consider obtaining an upright X-ray to demonstrate the degree of displacement in midshaft clavicle fractures.
C
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Medical management

Pain management
As per AOTA/EAST 2023 guidelines:
Consider administering NSAIDs (such as ketorolac) for pain management in adult patients with a traumatic fracture.
C
Insufficient evidence to recommend the preferential use of either selective NSAIDs (COX-2 inhibitors) or nonselective NSAIDs.
I

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  • Antibiotic prophylaxis

Nonpharmacologic interventions

Nonoperative management: as per AAOS 2023 guidelines, consider preferring slings over figure-of-eight braces for immobilization in patients with acute clavicle fractures.
E

Therapeutic procedures

Low-intensity pulsed ultrasound: as per AAOS 2023 guidelines, do not use low-intensity pulsed ultrasound for nonoperative management in patients with acute midshaft clavicle fracture, as it does not result in accelerated healing or lower nonunion rates.
D

Surgical interventions

Surgical repair, lateral fracture
As per AAOS 2023 guidelines:
Consider performing surgical repair in patients with displaced lateral fractures with disruption of the coracoclavicular ligament complex.
E
Consider using lateral locking plates over hook plates for the treatment of lateral (Neer type II) clavicle fractures in adult patients, as they have fewer complications and better functional outcomes.
C

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  • Surgical repair (midshaft fracture)

Specific circumstances

Adolescent patients: as per AAOS 2023 guidelines, avoid offering surgical treatment over nonoperative management in adolescent patients with displaced midshaft clavicle fractures, as it is associated with similar union rates and substantial revision surgery rates for implant removal.
D

Follow-up and surveillance

Risk of nonunion: as per AAOS 2023 guidelines, recognize that:
nonmodifiable risk factors age and sex do not predict patient-reported functional outcomes after midshaft clavicle fracture, regardless of treatment modality
smoking tobacco increases the rate of nonunion in clavicle fractures and leads to inferior clinical outcomes
increasing displacement and/or comminution of midshaft clavicle fractures May be associated with higher rates of nonunion after nonsurgical treatment in adult patients.
B