Clavicular Fracture

Classification

Fractures are often categorised by their location along the clavicle:

• Middle (mid-shaft) third: Most common site

• Lateral (distal) third

• Medial (proximal) third

____________________________________

Mechanism

Typically results from a direct blow to the lateral shoulder, a fall on an outstretched hand, or a high-impact collision in sports. The proximal fragment may be pulled superiorly by the sternocleidomastoid, while the distal fragment can be displaced downward by the weight of the arm.

____________________________________

Management (when no severe neurovascular compromise)

• Immobilisation: A broad arm sling for approximately 2 weeks to minimise movement and allow early callus formation

• Analgesia: Paracetamol (regular dosing) and/or NSAIDs (e.g. ibuprofen) for pain control over 2–3 weeks, unless contraindicated

• Activity restrictions: Avoid contact or high-risk sports for at least 6 weeks after sling removal to reduce re-injury risk

• Follow-up: Patients should return for re-assessment if pain worsens, deformity increases, or neurovascular symptoms develop

• Education: A palpable lump at the fracture site is common and may persist for about a year. Skin irritation can occur from the sling. Malunion and nonunion are possible but relatively uncommon with mid-shaft fractures managed conservatively

____________________________________

Indications for orthopaedic referral

• Displaced middle or lateral-third fracture, especially if significantly angulated

• Shortened middle-third fracture >2 cm in individuals over 12 years of age

• Open fractures or those with skin tenting, given the risk of compromised soft tissues

• Neurovascular injury, including evidence of brachial plexus compromise or compromised subclavian vessels

____________________________________

Follow-up guidelines

• Children under 11 years: Usually no routine follow-up needed if the fracture is not severely displaced and the child is pain-free. Significant remodelling potential means these fractures often heal well

• Children 11 years and older: GP or fracture clinic review in 1 week, ideally with repeat X-ray if there is displacement, to ensure ongoing acceptable alignment

• Adults: Reassess clinically within 1–2 weeks. If persistent or severe pain, repeat imaging may be considered to evaluate for nonunion or excessive displacement

____________________________________

Additional considerations

• Healing times vary: Children typically heal more quickly (4–6 weeks) than adults (8–12 weeks). Compliance with immobilisation and gradual return to activity is crucial for optimal recovery

• Physiotherapy can be introduced after the initial immobilisation phase to maintain shoulder range of motion and prevent stiffness. Early gentle pendulum exercises may be advised depending on pain levels

• Complications include malunion, nonunion (especially in smokers or older patients), and rare neurovascular compromise. Medial third fractures carry a higher risk of complications due to proximity to great vessels and brachial plexus

• Athletes and manual labourers may require extended rehabilitation or, in some cases, surgical fixation if the fracture is severely displaced or if early functional return is critical