Managing Mid-Clavicle Fractures in Children: Recovery Tips and Concerns

Midshaft clavicle fracture of the left shoulder?

My son (11 years old) fell while running during gym class when a classmate stepped on his foot, resulting in a mid-shaft clavicle bump, resembling a triangular peak (the bone is slightly overlapping).
The doctor said it was not displaced, so surgery is not necessary.
He initially used a triangular bandage to immobilize the left arm.
After a week, we returned to the doctor, who applied a figure-eight bandage and took X-rays.
The prominent bump appeared flatter (though still slightly raised).
However, my son is not listening; he is eager to use his right hand to shoot basketballs as soon as his left shoulder feels better.
I am concerned about whether this will affect the recovery of his left shoulder.
When I asked the doctor, he advised against playing and suggested we return in two weeks to assess the healing progress.
Since we can't monitor him closely at school, I am worried he might forget our instructions not to play basketball.
Thank you for your response.

Vin, 10~19 year old female. Ask Date: 2022/02/08

Dr. Chen Yongxue reply Orthopedics

Please remind the child to strictly follow the doctor's advice and refrain from playing basketball for the time being.
Thank you.

Reply Date: 2022/02/08

More Info

Managing mid-clavicle fractures in children can be a challenging process, especially when it comes to ensuring proper recovery and preventing complications. In your case, your 11-year-old son has sustained a mid-clavicle fracture, and while the initial assessment indicated that surgery was not necessary, it is crucial to follow the doctor's recommendations closely to ensure optimal healing.

Recovery Tips for Mid-Clavicle Fractures
1. Follow Medical Advice: It's essential to adhere to the doctor's instructions regarding activity restrictions. Since your son has been advised not to engage in activities like basketball for at least two weeks, it's important to enforce this rule. Engaging in sports too soon can lead to improper healing, which may result in complications such as malunion or nonunion of the fracture.

2. Use of Immobilization Devices: The use of a triangular sling and figure-eight bandage is a common practice to immobilize the shoulder and clavicle area. This helps to stabilize the fracture and reduce movement that could hinder healing. Ensure that the sling is worn as prescribed, especially during physical activities.

3. Pain Management: If your son experiences pain, over-the-counter pain relief medications like acetaminophen or ibuprofen can be used, following the dosage guidelines for his age and weight. Pain management is crucial as it can help him feel more comfortable and less likely to engage in activities that could jeopardize his recovery.

4. Monitor for Complications: Keep an eye out for any signs of complications, such as increased swelling, redness, or fever, which could indicate an infection or other issues. If you notice any concerning symptoms, contact your healthcare provider immediately.

5. Encourage Gentle Movement: While immobilization is important, gentle range-of-motion exercises may be encouraged once the doctor gives the green light. These exercises can help maintain flexibility and prevent stiffness in the shoulder joint. However, these should only be done under the guidance of a healthcare professional.

6. Reinforce Activity Restrictions: Since children can sometimes forget or ignore restrictions, it may be helpful to communicate with your son about the importance of following the doctor's advice. You might consider setting reminders or having a discussion about the potential consequences of not adhering to the restrictions.

Concerns About Early Activity
Engaging in activities like basketball too soon can lead to several issues:
- Malunion: This occurs when the bones heal improperly, which can lead to a deformity or functional impairment of the shoulder.

- Nonunion: In some cases, the fracture may not heal at all, requiring surgical intervention later on.

- Increased Pain and Discomfort: Early activity can exacerbate pain and prolong the recovery process.

Follow-Up Care
After the initial recovery period, follow-up appointments are crucial. The doctor will likely perform X-rays to assess the healing progress. If the fracture shows signs of proper healing, your son may gradually return to normal activities. However, if there are concerns about the alignment or healing of the clavicle, further intervention may be necessary.

Conclusion
In summary, managing a mid-clavicle fracture in children requires careful attention to medical advice, proper immobilization, and monitoring for complications. Encourage your son to avoid activities that could jeopardize his recovery, and maintain open communication about the importance of following the doctor's recommendations. With proper care and adherence to guidelines, most children can expect a full recovery from a mid-clavicle fracture.

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