IMMOBILIZATION METHOD

A systematic review of literature yielded no studies that met inclusion criteria for this topic. Sling immobilization has been the mainstay of non-operative treatment in most studies evaluating non-operative treatment of clavicle fractures (Ahrens 2017, Smekal 2009, COT 2007, Ban 2021, Woltz 2018). Other modalities have included Collar and Cuff (Robinson 2013) and Figure-of-Eight bandage (Naveen 2017, Tamaoki 2017). However, these have been less studied overall compared to ORIF. A randomized trial for mid-shaft clavicle fractures treated non-operatively, demonstrated no improvement in function, reduced pain, and improved patient comfort/compliance with sling when compared to Figure-of-Eight (Ersen 2015). Simple Sling immobilization is easily applied, well tolerated, and cost effective.

Benefits/Harms of Implementation

Sling immobilization offers a simple, cost-effective technique for non-operative care. The risks, or harms of implementation are minimal for this specific intervention. The technique is ubiquitous with minimal opportunity for the generation of health disparities or access to treatment.

Outcome Importance

Identifying optimal immobilization strategies for patient comfort while maximizing outcomes is critical for patient satisfaction and improving the success of non-operative management when indicated

Cost Effectiveness/Resource Utilization

Sling immobilization is simple, and low cost with few significant risks compared to more complex or expensive immobilization methods

Acceptability

Surgeons and patients are likely to accept that sling immobilization may be optimal for non-operative management given its prevalence, simplicity of use and low cost.

Feasibility

Recommendations, even those with consensus only support, inform and help counsel patients regarding treatment. The use of sling immobilization is inexpensive and can be applied broadly across health care settings and environments.

Future Research

Further research regarding the optimal immobilization method(s) including sling, collar and cuff or figure of eight sling, is needed so that surgeons can make evidence-based treatment decisions to optimize patient comfort, and outcome.