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Do I need surgery for clavicle fracture?

Q: I am a 19 years old boy, and I sustained a clavicle fracture 10 days back. It is a complete fracture with no swelling. The medial side bone has overlapped lateral side about 1 cm anteriorly. The recent x-ray is also just like the previous x-ray. Will it unite itself or do I need to opt for surgery?

A:Traditionally, clavicle fractures have been treated non-operatively, and the consensus was that they all heal. While it is true that if all clavicle fractures are considered together, the vast majority will heal with non-operative management, including a figure-of-eight brace or a simple shoulder sling. Current management of medial clavicle fractures has remained non-operative, and results have remained consistently good. Significant displacement is rare due to the extensive ligamentous attachments. No proven benefit of any specific technique of immobilization exists, so the choice of immobilization will depend on the comfort and functional demands of the patient. Immobilization may be discontinued when pain and palpable motion are no longer present at the fracture site. Stiffness is usually not a problem after non-operative treatment of clavicle fractures. If the patient does require some rehabilitation, it should include forward elevation and external rotation. Labourers may return to lifting light loads after 6 weeks and full duty at 12 weeks. Athletes may return to contact sports after 3 months. Treatment of middle third fractures remains non-operative. Non-operative treatment can be divided into two categories: simple support of the extremity, as in a sling or a sling and swath, and reduction and immobilization, typically with a figure-of-eight brace. These treatment options are applicable for almost all middle third clavicle fractures, with the exception of those that are severely displaced. Given the excellent results obtained with non-operative treatment of uncomplicated midclavicular fractures, non-operative treatment in a figure-of-eight brace or regular support sling is recommended. Open reduction and internal fixation of these injuries is recommended for patients with displaced middle third clavicle fractures with greater than 2 cm of shortening and nonunion. In your case I would recommend non-operative management as detailed above.

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