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Clinical Practice Guidelines

Clavicle fractures - Fracture clinics

  • Fracture Guideline Index

    See also: Clavicle fractures - Emergency Department 

    1. How often should these fractures be followed up in fracture clinics?
    2. What should I review at each appointment?
    3. What are the potential complications associated with this injury?
    4. When should I refer for an orthopaedic consultant opinion?
    5. What are the indications for discharge?
    6. Parent information fact sheet (PDF)

    1. How often should these fractures be followed up in fracture clinics?

    Table 1:  Recommended follow-up schedule for clavicle fractures.

    Fracture type

    First appointment

    Subsequent review appointments

    Discharge advice to parents

    Middle third (≥11 years or displaced)

    At 7 days post-injury. Repeat x-ray is usually not required

    Advise parents to remove sling at 2 weeks

    At 4 weeks post-injury. Repeat x-ray not required

    A lump may be felt at the fracture site, which may be visible.  The lump will decrease as remodelling occurs.  It is more complete in younger patients

    Lateral third (undisplaced)

    At 5-7 days post-injury with x-ray.

    At 2 weeks post-injury with x-ray

    Remove sling at 2 weeks if no displacement

    4 weeks post-injury

    For undisplaced fractures, a lump usually does not develop

    Contact sports and activities should be avoided for approximately 6 weeks post removal of sling


     2. What should I review at each appointment?

    Review is based on assessing for neurovascular compromise, loss of position and guiding exercise and return to activities.

    Lateral third fractures require regular x-ray to detect loss of position or instability.

    For middle third fractures, loss of position is not a factor.  Review is for clinical evidence of callus formation and stability to allow return to movement.  This usually occurs at four weeks. 

    Surgery may be indicated if skeletally mature or shortening >2 cm.

    3. What are the potential complications associated with this injury?

    • Neurovascular compromise
      • Early injury with trauma
      • Late compromise with excessive callus development (rare) 
    • Nonunion - defined on x-ray at three months
    • Acromioclavicular (AC) joint instability and potential degeneration
    • Malunion - bony prominence, loss of contour of shoulder
    • Loss of power with forward elevation - i.e. footballer

    4. When should I refer for an orthopaedic consultant opinion?

    Indications for a consultant orthopaedic surgeon opinion are:

    • established neurovascular injury
    • loss of position of lateral third fracture, with instability or AC joint incongruence
    • nonunion with loss of function or pain
    • shortening in skeletally mature individual

    5. What are the indications for discharge?

    Patient can be discharged (usually at four weeks) when:

    • fracture is stable and pain has subsided
    • return of active range of shoulder movement
    • clinical evidence of callus formation around fracture site

    References (Outpatient setting)

    Hunter JB. Fractures around the shoulder and humerus. In Children's Orthopaedics and Fractures,3rd Ed. Benson M, Fixsen J, Macnicol M, Parsch K (Eds). Springer, London 2010. p.717-30.

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    Content developed by Victorian Paediatric Orthopaedic Network.  To provide feedback, please email rch.orthopaedics@rch.org.au