Broad Arm Sling better than Figure of 8 Bandage for Conservative Management of Clavicle Fracture

A prospective randomised trial was conducted to compare the results of conservative management of middle third clavicular fracture using the figure of 8 bandage and broad-arm sling. Nihar Modi et al found that - Broad-arm sling proves to be a better modality of management for middle-third clavicular fractures in terms of ease of application, pain relief, incidence of malunion, and functional outcomes.

The available evidence from current literature is limited regarding the effectiveness of the different methods of conservative interventions and the best conservative treatment for middle-third clavicle fractures in adults is controversial.

296 patients with middle-third clavicle fracture were included in the study conducted.

The cases with open fractures, fracture involving neurovascular complications or skin tenting, pathological fracture, history of frozen shoulder or any pre-existing limb disease which could influence the result, Ipsilateral upper limb fractures and/or dislocation were excluded from the study.

Randomisation was done in a non-stratified manner in two groups.

Group 1—Figure of 8 bandage was to be used for 4 weeks and was applied with proper tightening. Patients and relatives were educated regarding regular tightening of the brace. The figure of 8 bandage needs to be adjusted, so that the shoulder is pressed back in an arched position, such as a back-stretch. Figure of 8 bandage allowed the dominant hand to remain free and simple activities were allowed.

Group 2—A standard broad arm sling was given for 4 weeks. Upper limb was immobilised with a sling in internal rotation and patients were advised to flex and extend the elbows four times a day for 10 min to prevent elbow stiffness. The only analgesia permitted in both groups was paracetamol and those who could not comply and required further analgesia were excluded.

The broad arm sling group showed a significantly better VAS score in the first 4 weeks.

DASH score was significantly superior in the broad arm sling group in the initial 4 weeks, but with similar outcome thereafter.

Constant scores showed a good outcome for both groups at the final follow-up, whereas the Nottingham Clavicle Score was significantly superior in the broad arm sling group at the 2 year follow-up. A satisfactory outcome was achieved with respect to the radiological parameters, without any significant difference between the 2 groups.

Incidence of malunion was significantly higher in figure of 8 bandage group.

The authors concluded that - with better pain relief, faster functional recovery, fewer union related complications and overall better patient compliance, the authors found broad arm sling to be a better modality of conservative management of middle third clavicle fractures, and thus strongly advocate its use over figure of 8 brace. 

Further reading:

Broad Arm Sling vs Figure of 8 Bandage: The Better Choice in Conservative Management of Middle Third Clavicle Fractures in Indian Population

Nihar Modi, Shaswat Mishra et al

Indian Journal of Orthopaedics (2022) 56:1394–1402

https://doi.org/10.1007/s43465-022-00652-1