Conservative Treatment in Neer Type II Distal Third Clavicle Fracture: A Case Report

Abstract

Introduction: Clavicle fractures, common among young athletes, often result from falls onto the shoulder. The Neer classification guides treatment decisions based on ligament and joint involvement. While older studies favored nonoperative treatment, recent research suggests surgery may be beneficial, especially for certain fractures. Recommendations vary, with non-surgical options for non-displaced fractures and surgery for displaced distal third fractures, particularly type II and V. The choice between operative and non-operative management remains debated, as both may yield similar functional outcomes. Case report: A 38-year-old hotel manager presented with left shoulder pain following a motorcycle accident. Examination revealed a displaced fracture of the left clavicle, with tenderness and limited range of motion. Despite the fracture, he opted for nonoperative management with an arm sling. At three weeks, his pain improved, and X-rays showed better alignment. By six weeks, pain and stiffness had subsided, and X-rays indicated callus formation. At 18 weeks, he had full range of motion and strength, with visible callus formation on imaging. He continued physiotherapy for optimal recovery. Discussion: In recent years, managing clavicular fractures has shifted towards open reduction and internal fixation (ORIF) due to high non-union rates with conservative treatment. A 38-year-old man with a displaced Neer type II distal third clavicle fracture chose nonoperative treatment despite controversy. He showed significant improvement after six weeks, opting for physiotherapy. Conclusion: Limitations include the fracture occurring in a non-dominant upper limb and the rarity of Neer type II clavicular fractures, warranting further research. Keywords: Clavicle fracture, Neer type II clavicular fracture, conservative treatment.