Yes, a lateral third fracture clavicle may need sugrical repair if it is displaced. That's the only class, all others can be treated with sling support.
- Class A (middle third fractures): Some orthopedists recommend an immobilization technique for midclavicular fractures; this is the clavicular (figure-of-eight) splint. This splint is applied after closed reduction of the fracture, which is accomplished by pulling the shoulders up and back. Such reductions are difficult to maintain and may be associated with increased discomfort at the fracture site. The advantage of the figure-of-eight harness is that it gives patients the ability to use both hands. The literature, however, shows no real difference in outcomes between patients treated with a figure-of-eight splint versus a sling.3 Healing may occur as rapidly as 2 weeks for infants, with most adults healing in 4-6 weeks. Immobilization should remain until repeat radiographs show callus formation and healing across the fracture site.
- Class B (distal third fractures): Type I (nondisplaced) and type III (articular surface involvement) fractures are treated symptomatically with ice, analgesics, and a sling for support. Early motion with passive shoulder range-of-motion exercises is strongly urged to prevent the development of degenerative arthritis and to reduce the risk of adhesive capsulitis. More urgent orthopedic consultation (before 72 hours) is recommended for type II (displaced) lateral clavicle fractures because these fractures have a 30% incidence of nonunion and may require surgical repair.
- Class C (proximal third): Medial third clavicle fracture management includes ice, analgesics, and a sling for support. Displaced medial-third fractures require orthopedic referral for reduction. Medial clavicle fractures may be associated with intrathoracic injuries or the development of late complications, such as arthritis.