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What is the appropriate treatment for a clavicular fracture?

Q: My 12 years old son broke his right clavical two days ago. The X-rays show two complete breaks at the 1/3 and 2/3 regions. His collar bone is now shaped like a lighting bolt or a stretched out z. I am in the navy and the naval orthopaedic surgeons say that no surgery is required and prescribed him to just wear a splint for several months. He is to be re-evaluated after three weeks. He shows no signs of nerve damage, it was not compound, and his breathing is not hindered. My question is about the drooping of the shoulder. They say it will mould into one bone and the bone deposits will slowly subside, but with a break in the middle measuring over 1.5 inches, will my son be malformed? Please provide any assistance you can. I feel this is a situation that requires surgery, what do you feel?

A:A fall on the shoulder is the most common cause for a clavicular fracture, which traditionally is managed conservatively with good outcomes though with variable amounts of cosmetic deformity (a bump under the skin at the fracture site). Conservative treatment entails the use of either a shoulder sling or a figure-of-eight brace. Present literature says that medial (inner half of the bone) clavicle fractures are best managed conservatively while there is no consensus on the treatment of middle and lateral (outer half of the bone) clavicle fractures. A fracture of the medial or middle third is managed non-operatively except if there is significant displacement of the bone or shortening. The sling or brace is used till pain disappears and there is no movement of the bone at the site of fracture. Light lifting of weight is permitted after 6 weeks and contact sports can be resumed after about 3 months. Operative treatment is best suited for more complicated fractures of the middle third of the clavicle ¡V if there is shortening of the fracture greater than 2 cm. In that case open reduction and internal fixation of the bone is required. Treatment of fractures of the distal third are controversial but surgical fixation (intramedullary wire or plate & screws) is preferred by most, especially in case of displacement. You need to discuss with the doctor and be guided by his assessment.

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