Management of Trabecular Microfracture of the Clavicle – Evidence‑Based Recommendations

Risk Factors and Prevention

Smoking increases the risk of non‑union even in minor clavicular injuries such as trabecular microfractures. The American Academy of Orthopaedic Surgeons advises tobacco‑cessation counseling for patients with these injuries. 1

Bone‑marrow edema on MRI should not be interpreted as an acute displaced clavicle fracture that mandates surgical fixation. Proper correlation with plain radiographs is required to avoid unnecessary surgery. 2
Upright radiographs provide a more accurate assessment of true displacement than supine views when a structural fracture is suspected. This imaging approach helps differentiate true fractures from stress‑related edema. 4

Immobilization with a simple sling for comfort and protection is the recommended initial treatment for non‑displaced or minimally displaced clavicular injuries. This recommendation follows the American Academy of Orthopaedic Surgeons’ guideline for stress‑related clavicle injuries. 1
Patients should avoid repetitive overhead activities and heavy lifting during the healing phase, with a gradual return to activity once symptoms permit. This activity‑modification strategy is endorsed by Praxis Medical Insights. 4

Surgical referral is reserved for displaced mid‑shaft clavicle fractures with >2 cm shortening, not for trabecular microfractures. The guideline specifies that these microfractures do not meet operative criteria. 4
Other indications for orthopedic surgery (e.g., >100 % fragment displacement, unstable distal clavicle fractures with coracoclavicular ligament disruption, open fractures, or neurovascular compromise) are not applicable to trabecular microfractures. These criteria are outlined in the Praxis Medical Insights guideline. 4

Clinical reassessment should occur at 2–4 weeks to evaluate pain resolution and shoulder function. Imaging is only repeated if symptoms persist beyond 6–8 weeks or worsen. 4
Urgent reassessment is required if there is development of skin tenting, neurovascular symptoms, a significant increase in deformity suggesting fracture displacement, or failure to improve after 6–8 weeks of conservative care. These red‑flag criteria are part of the Praxis Medical Insights recommendations. 4