If you break your collarbone, what is the best treatment? Is a sling or brace or surgery for a clavicle fracture the best option?

Aaron writes:

Hi Doc,

I have a question about broken clavicle remediation. I’m 35 and broke my clavicle last week. I’ve read conflicting reports on whether or not to wear a sling, a figure-of-8 strap or just go for the surgery.

I’ve read in cases where there is just a fracture and no displacement, a sling or 8 should suffice, but what are your thoughts on executing surgery and installing a plate in cases where displacement has occurred (2-3 cm) and the individual would like to return to an active lifestyle of mountain biking and contact sports? I know you can’t diagnose over the internet, but any thoughts you have on sling, figure 8 or surgery will help in my decision on Monday.

Thanks so much for your thoughts and your website has been a big help!

The management of clavicle fractures has certainly been evolving over the last few years.

Non-surgical treatment of a clavicle fracture

In general, I think that nonoperative management of clavicle fractures is acceptable for a large percentage of these injuries. If the ends of the bone line up fairly well with minimal displacement, the use of a sling or figure-of-eight strap is definitely appropriate. I am fairly aggressive getting people out of the sling once the fracture starts to heal in order to start working on range of motion and strengthening. Use of the sling or strap is more for the patient’s comfort than to get it to heal properly. While the fracture is still new, patients can often feel the fracture edges moving against each other, so for the first few weeks I think a sling is fine.

In this x-ray, notice how the ends of the fractured clavicle are widely separated.

Surgery for a clavicle fracture

Surgical treatment, either using a pin down the center of the bone or a plate and screw construct, has become more accepted for displaced fractures. In situations where the ends of the bones are not touching, especially when there is significant separation, I think surgery is appropriate. A study in The American Journal of Sports Medicine notes how surgical management might be more appropriate for athletes of contact and collision sports.

This x-ray, taken right after surgery, shows better alignment of the fracture ends.

In these displaced fractures, I think that all active people, not just athletes, are less likely to have issues with weakness or lingering soreness with surgery than with nonoperative management. surgery for a clavicle fracture lines up the ends of the bone better, creating less of a lump at the fracture site. Surgical treatment does make the surgeon more comfortable knowing that the fracture is more likely to heal. The first few visits obtaining x-rays to follow nonoperative management of displaced fractures is always somewhat nerve-racking, as it is hard to know if that fracture will go on to heal. Certainly primary fixation of a fracture is easier and more reliable than treatment of a nonunion. Also, surgery allows the patient to start physical therapy for motion and strengthening much earlier, as the fracture doesn’t need to be protected in a sling or other immobilization for a long at all.

It will be interesting to see if the tide for management of clavicle fractures swings in the opposite direction (surgical treatment) in the coming years as long-term data regarding pin or plate and screw fixation of these fractures becomes more available.

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