Monitoring
There is no universal agreement on follow-up for clavicle fractures. However, in the author’s opinion it is reasonable to reassess the patient 1 week after injury to ensure adequate pain management, assess for compliance with treatment recommendations, and evaluate for evidence of additional or new fracture displacement. It is also an opportunity to assess for the emergence of complications, such as skin, soft tissue, or neurovascular injury from the sling or unexpected underlying structural damage. Repeat imaging can be obtained as appropriate for suspected displacement, as well as to document fracture healing (especially prior to resumption of contact sports or similar intense physical activity). If operative management is performed, postoperative follow-up is determined by the surgeon.
One UK study of 346 children ages 2-16 years with clavicle fractures presenting to a hospital fracture clinic found that for those with isolated, uncomplicated fractures, follow-up review had no impact on fracture outcome. The study authors concluded that these children may be safely discharged after first assessment in the fracture clinic without further follow up.[69] Similarly, a retrospective analysis of 340 children ages <18 years presenting with clavicle fractures to a hospital in Canada with no or minimal complications concluded that routine clinical or radiographic follow-up is unnecessary for children managed nonsurgically.[81]
Smoking has been associated with an increased risk for symptomatic nonunion of displaced midshaft clavicle fracture in patients treated nonoperatively.[35][85] Therefore, assess the patient’s smoking status and offer smoking cessation counseling as appropriate.
Use of this content is subject to our disclaimer