Our godchild is in the emergency room being evaluated for a collar bone fracture. It sounds like it’s a toss up between a sling or surgery. How can two such different treatments both be okay?

The clavicle known more commonly as the “collar bone” is the most commonly fractured bone in children. No surprise there since falling on the point of the shoulder is the way the bone gets broken in the first place and falling is what young children do so well!

Treatment choices are usually between nonoperative care and surgery. The decision can be easy in some cases (e.g., a simple undisplaced fracture) or complex due to other injuries or the severity of the fracture.

Children do have a very thick outer covering of bone around the clavicle limiting displacement (separation) of the broken bones. They also have excellent ability to heal and remodel bone compared with adults. A sling or figure-8 brace may be all that’s needed for a few weeks before easing back into full activities.

Sometimes surgery is necessary for children. The indications for operative treatment include multiple trauma to the body (usually signaling a more severe clavicular fracture), other shoulder injuries, shortened fractures (the two ends of the bones telescope onto each other), or comminuted fractures (many bone pieces).

When surgery is needed, there isn’t one operative method that works best for all children. The surgeon must consider the needs of the child and the concerns of the parents or family. The surgeon’s own experience and expertise also play a role in decisions about treatment.

Many decisions go into the operative care of children. Age, size, growth status, location and type of clavicular fracture, and activity level are just a few factors. Then type of fixation (e.g., metal plate, screws, pins, wires), type of incision, and potential for complications must be considered.

There’s no cookie cutter recipe for the treatment of clavicular fractures in young children and teens. The fact that many of these patients are still growing plays a huge role in the decision about what kind of treatment is best. It sounds like the team treating your godchild is carefully considering all options and possible factors that could affect treatment and outcomes.