**Clavicle Fracture Management: Non-Operative Treatment vs. Operative Fixation and Plate Options**
S-clavicle plate
Clavicle (collarbone) fractures are among the most common orthopedic injuries, accounting for 2–5% of all adult fractures and up to 10–15% in children. Traditionally managed with slings and rest, modern evidence has reshaped treatment paradigms—especially for displaced midshaft fractures. This review compares **non-operative care** versus **surgical fixation**, and outlines the **most effective plate types** used in contemporary practice.
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### When Is Non-Operative Treatment Appropriate?
Non-operative management remains the gold standard for:
- **Minimally displaced fractures** (<100% displacement, no skin tenting)
- **Non-comminuted fractures**
- **Children and adolescents** (excellent remodeling potential)
- **Patients with high surgical risk or low functional demands**
#### Protocol:
- **Sling immobilization** for 2–4 weeks
- **Early pendulum exercises** to prevent shoulder stiffness
- **Gradual return to activity** by 6–8 weeks
#### Outcomes:
- Union rates exceed **95%** in non-displaced fractures
- Most patients regain full function with minimal cosmetic deformity
#### Risks:
- **Nonunion**: Occurs in 5–15% of displaced midshaft fractures
- **Malunion**: Shortening >2 cm correlates with weakness and fatigue
- **Persistent pain or cosmetic concerns**
A landmark 2007 study (Canadian Orthopaedic Trauma Society) showed that **displaced midshaft clavicle fractures** treated non-operatively had **higher nonunion rates (15% vs. 0%)** and **worse functional scores** at 1 year compared to surgery.
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### Indications for Operative Fixation
Surgery is now strongly recommended for:
- **Displaced midshaft fractures** with >100% displacement or >2 cm shortening
- **Open fractures**
- **Floating shoulder** (concomitant glenoid neck fracture)
- **Neurovascular compromise**
- **Polytrauma patients** needing early mobilization
- **Athletes or laborers** requiring rapid return to function
Operative treatment reduces nonunion risk to <1% and accelerates functional recovery.
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### Surgical Options: Plate Fixation Types
While intramedullary nails exist, **plate fixation remains the most common and versatile method**. The choice of plate depends on fracture pattern, surgeon preference, and soft tissue considerations.
#### 1. **Reconstruction Plates (3.5 mm)**
- **Design**: Thin, malleable, with oval holes for compression
- **Pros**: Easy to contour; ideal for simple transverse fractures
- **Cons**: Lower fatigue resistance; higher risk of hardware irritation
- **Best for**: Non-comminuted fractures in low-demand patients
#### 2. **Locking Compression Plates (LCP) – Superior Plating**
- **Design**: Anatomically pre-contoured for the clavicle’s superior surface
- **Pros**: Strong fixation in osteoporotic bone; minimal soft tissue dissection
- **Cons**: Risk of **supraclavicular nerve injury** (due to superficial placement)
- **Note**: Once popular, but **superior plating is now discouraged** in many centers due to high hardware prominence and irritation rates (up to 30%).
#### 3. **Anterior-Inferior (Anteroinferior) Locking Plates**
- **Design**: Placed on the anterior-inferior cortex—away from skin and nerves
- **Pros**:
- Lower risk of hardware irritation
- Better biomechanical resistance to bending forces
- Preserves supraclavicular nerve branches
- **Cons**: Technically demanding; requires precise exposure
- **Current Gold Standard**: Supported by biomechanical and clinical studies showing **lower reoperation rates** and **higher patient satisfaction**.
#### 4. **Dual Plating (Superior + Anterior)**
- **Use**: Reserved for **severely comminuted fractures**
- **Pros**: Provides 360° stability
- **Cons**: Increased surgical time, soft tissue stripping, and infection risk
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### Complications: Non-Operative vs. Operative
| Complication | Non-Operative | Operative |
|-------------|----------------|-----------|
| **Nonunion** | 5–15% (displaced) | <1% |
| **Malunion** | Common (shortening) | Rare |
| **Hardware irritation** | None | 10–30% (higher with superior plates) |
| **Infection** | None | 1–3% |
| **Nerve injury** | None | Rare (supraclavicular nerve) |
| **Reoperation** | Rare | 5–15% (mostly for hardware removal) |
> 💡 **Key Insight**: Up to **30% of patients with superior plates request hardware removal** due to discomfort—making anterior-inferior plating increasingly preferred.
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### Rehabilitation Protocol
- **Non-operative**:
- Sling × 2–4 weeks
- Passive ROM at 2 weeks
- Strengthening at 6 weeks
- Full activity by 12 weeks
- **Operative**:
- Sling × 1–2 weeks
- Passive ROM within days
- Active motion at 4–6 weeks
- Return to sports at 8–12 weeks
Surgical patients typically return to work and sports **4–6 weeks earlier** than non-operative counterparts.
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### Conclusion
The management of clavicle fractures has evolved from universal non-operative care to **individualized, evidence-based decision-making**. While non-operative treatment remains ideal for simple fractures, **operative fixation is superior for displaced, comminuted, or high-demand cases**.
Among surgical techniques, **anterior-inferior locking plate fixation** offers the best balance of stability, low complication rates, and patient comfort—making it the modern standard of care.
At BoneFractures.org, we advocate for treatment plans that prioritize **anatomical restoration, functional recovery, and patient-centered outcomes**—because every clavicle fracture deserves a tailored approach.
*— Written by Dr. Attia, Orthopedic Consultant*
*Published on BoneFractures.org – Evidence-based fracture care for patients and professionals.*