eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics
Fracture, Clavicle: Follow-up
Updated: Jul 28, 2009
Follow-up
Further Inpatient Care
The following require consideration for inpatient management:
- Open fractures
- Associated medical or traumatic conditions
- Pain control
Further Outpatient Care
- Orthopedic follow-up care
- Patient education
- Early physical therapy (eg, range of motion exercises) if indicated
Deterrence/Prevention
- Injury avoidance education
- Adequate protective gear for participation in certain sports
- Seat belt utilization
- Drug and alcohol counseling as needed
Complications
- Fractures of the middle third of the clavicle have been associated with injuries to the neurovascular bundle and the pleural dome.
- Complications after fractures of the medial third resemble complications associated with posterior sternoclavicular dislocations including pneumothorax or compression or laceration of the great vessels, trachea, or esophagus.
- Brachial plexus compression resulting from hypertrophic callus formation (may cause peripheral neuropathy)
- Delayed union or nonunion (especially with type II distal third fractures and fractures with >2 cm of shortening)
- Poor cosmetic appearance
- Posttraumatic arthritis
- Intrathoracic injury
- As with first rib fractures, great force is necessary to cause proximal third clavicle fractures; excluding underlying injuries is imperative (see Media file 5).
Clavicle fracture with rib fractures. Remember to look for associated injuries.
- Pneumothorax
- Subclavian artery and vein injury
- Internal jugular vein injury
- Axillary artery injury
Prognosis
- The prognosis of clavicle fractures is excellent in children.
- The prognosis of clavicle fractures is excellent in adults with proper follow-up care, early detection, and treatment of complications.
- Younger children generally require shorter periods ofimmobilization (2-4 wk) than adolescents and adults (4-8 wk).
Patient Education
- Patients should use of a sling or sling and swathe.
- Vigorous competitive play should be avoided until the bone healing is solid.
- A figure-of-eight bandage (clavicle strap) should be used.
- Educate patients about proper placement and adjustment techniques.
- Paresthesias or edema in the hands or fingers indicate that the strap is too tight and should be removed.
- The purpose of this bandage is to reduce pain by decreasing fracture fragment movement, not necessarily to maintain perfect alignment.
- This strap may be combined with a sling for added comfort.
- Neonatal clavicle fracture
- Advise parents to minimize pressure and movement of the ipsilateral arm during handling of the child.
- The parent may try to pin the infant’s shirt sleeve of the affected arm to the front of the shirt to minimize movement.
- For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education articles, Broken Collarbone and Shoulder Dislocation.
Miscellaneous
Medicolegal Pitfalls
- Failure to recognize and treat associated severe injuries
- Failure to refer patients at risk of complications to an orthopedist
The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Lawrence C Brilliant, MD, to the development and writing of this article.
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References
Simon RR, Koenigsknecht SJ. Clavicle fractures. In: Emergency Orthopedics: The Extremities. 5th ed. McGraw-Hill; 2007.
Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am. Feb 2009;91(2):447-60. [Medline].
Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev. Apr 15 2009;CD007121. [Medline].
Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma. Feb 2009;23(2):106-12. [Medline].
Pujalte GG, Housner JA. Management of clavicle fractures. Curr Sports Med Rep. Sep-Oct 2008;7(5):275-80. [Medline].
Low AK, Duckworth DG, Bokor DJ. Operative outcome of displaced medial-end clavicle fractures in adults. J Shoulder Elbow Surg. Sep-Oct 2008;17(5):751-4. [Medline].
Further Reading
Keywords
clavicle fracture, clavicle fracture treatment, clavicular fractures, fractured clavicle, clavicula, collar bone, collarbone, displaced clavicle fractures
