Management of clavicle fractures

Fractures of the clavicle are among the most common fractures seen by family physicians. Common mechanisms of injury include a fall on an outstretched hand or direct trauma to the bone. Fractures of the middle third of the clavicle are the most common and usually heal without complication when managed with immobilization using a sling or figure-of-8 bandage. Fractures of the distal clavicle often are overlooked and may be difficult to distinguish from an acromioclavicular separation. These fractures are classified into three types. Types I and III fractures of the distal clavicle usually heal with symptomatic treatment. Type II fractures are displaced as a result of ligamentous disruption and usually require surgical repair. Fractures of the proximal third of the clavicle are uncommon. Nondisplaced proximal fractures are successfully treated with sling immobilization. Orthopedic referral is indicated for significant displacement or sternoclavicular dislocation. By following appropriate management guidelines, family physicians can successfully treat most clavicle fractures.