Clavicle fractures account for nearly 5% of all adult fractures, with high-energy events such as a blow to the shoulder on a sports field, a bicycle crash, or a motor vehicle collision commonly causing these fractures.
A recently updated clinical practice guideline (CPG) from the American Academy of Orthopaedic Surgeons (AAOS) is intended to help physicians develop an evidence-based approach to diagnosing and treating both skeletally immature and mature patients with clavicle fractures. By optimizing the treatment of these fractures, physicians can reduce the potential long-term negative physical and emotional impacts of the injury.
- Strong evidence that operative treatment of displaced midshaft clavicle fractures in adult patients is associated with higher union rates and better early patient-reported outcomes than non-operative treatment.
- Moderate evidence that low-intensity pulsed ultrasound (LIPUS) should not be used for non-operative management of acute midshaft clavicle fracture, as it does not result in accelerated healing or lower rates of non-union.
- Moderate evidence that lateral locking plates may have fewer complications and better functional outcomes than hook plates for the treatment of lateral (Neer Type II) clavicle fractures in adults.
- Surgical treatment of clavicle shaft fractures with an intramedullary nail or a single plate results in equivalent long-term clinical outcomes with similar complication rates.
In the absence of reliable evidence, the guideline notes that operative treatment in adolescent patients with displaced midshaft clavicle fractures may offer no benefit compared with non-operative treatment. In addition, the CPG suggests that a sling is preferred in most cases for immobilization of acute clavicle fractures as opposed to figure-of-8 brace.
This guideline is intended to be used by orthopaedic surgeons and other healthcare professionals treating isolated clavicle fractures. It offers accepted approaches to treatment and/or diagnosis and is not intended to be a fixed protocol. Patient care and treatment should always be based on a clinician’s independent medical judgment, giving the individual patient’s specific clinical circumstances.
Additional considerations outside the scope of the CPG are necessary for the treatment of clavicle fractures in the polytraumatized patient.
The CPG for the treatment of clavicle fractures is available here.