FACT SHEET: Clinical Practice Guidelines (CPG) for the Treatment of Clavicle Fractures

ROSEMONT, Ill. (January 10, 2023)—The American Academy of Orthopaedic Surgeons (AAOS) released an updated CPG to help healthcare professionals develop their own evidence-based approach to diagnosing and treating both skeletally immature and mature patients with clavicle fractures.

OVERVIEW AND PREVALENCE
Simply defined, a clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. This type of fracture accounts for nearly 5% of all adult fractures. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it snaps or breaks. High-energy events like a blow to the shoulder on a sports field, a bicycle crash or motor vehicle collision are common causes.

Clavicle fractures can result in long term negative functional consequences for the shoulder – particularly in the setting of fracture nonunion and malunion. By optimizing the treatment of clavicle fractures, physicians can reduce the negative physical and emotional impacts of the injury.

CPG HIGHLIGHTS
The CPG suggests:

• Strong evidence that operative treatment of displaced midshaft clavicle fractures in adult patients is associated with higher union rates and better early patient-reported outcomes than non-operative treatment
• Moderate evidence that low-intensity pulsed ultrasound (LIPUS) should not be used for nonoperative management of acute midshaft clavicle fracture, as it does not result in accelerated healing or lower rates of non-union
• Moderate evidence that lateral locking plates may have fewer complications and better functional outcomes than hook plates for the treatment of lateral (Neer Type II) clavicle fractures in adults
• Surgical treatment of clavicle shaft fractures with an intramedullary nail or a single plate results in equivalent long-term clinical outcomes with similar complication rates.

In the absence of reliable evidence, the guideline notes that operative treatment in adolescent patients with displaced midshaft clavicle fractures may offer no benefit compared to non-operative treatment. In addition, it is suggested that a sling is preferred in most cases for immobilization of acute clavicle fractures as opposed to figure-of-eight brace.

INTENDED CPG USERS?
This guideline is intended to be used by orthopaedic surgeons and other healthcare professionals treating isolated clavicle fractures. Additional considerations outside the scope of these guidelines are necessary for the treatment of clavicle fractures in the polytraumatized patient. The new CPG is intended to serve as an information resource for health care professionals and is not intended for use as a benefits determination document.

FOR MORE INFORMATION
The guideline offers accepted approaches to treatment and/or diagnosis and is not intended to be a fixed protocol. Patient care and treatment should always be based on a clinician’s independent medical judgment, giving the individual patient’s specific clinical circumstances.

The full CPG for the treatment of clavicle fractures is available through AAOS’ OrthoGuidelines website and free mobile app. For more information on the development process for AAOS clinical practice guidelines, please reference the Clinical Practice Guideline Methodology.

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