Surgical versus conservative interventions for treating fractures of the middle third of the clavicle

Thoracic outlet syndrome secondary to a mid-clavicle malunion

“…Two of the most common surgical methods of shaft clavicle fracture treatment are plate fixation and intramedullary fixation. The most recent systematic review comparing surgical versus conservative interventions for acute shaft clavicle fractures showed that surgical interventions do not result in an improvement in shoulder function 11. Therefore, it was concluded that treatment options must be tailored to individual patients and take into account their health-related preferences 11.…”

“…The most recent systematic review comparing surgical versus conservative interventions for acute shaft clavicle fractures showed that surgical interventions do not result in an improvement in shoulder function 11. Therefore, it was concluded that treatment options must be tailored to individual patients and take into account their health-related preferences 11. A cost minimisation analysis conducted by Walton et al 12 demonstrated that initial conservative treatment of displaced diaphyseal clavicle fractures followed by delayed surgery as needed is less costly for the healthcare provider than operative management.…”

Surgical treatment of displaced middle-third clavicular fractures: a prospective, randomized trial in a working compensation population

“…5,8,9,17 In a prospective, randomized study, Robinson et al 15 Also, radiologic signs of fracture healing on CT scan were present in a higher rate in the S group. At final followup, 9.6% of nonunion cases were found in the C group and no cases in the S group.…”

“…12,15,18 Currently, there is evidence that supports conservative or surgical treatment with open reduction and internal fixation (ORIF) of displaced middlethird fractures, causing some confusion. 2,3,8,15 Historically, the standard of care has been conservative treatment, because in most cases, clavicular fractures heal or progress toward an asymptomatic nonunion. 4,6,8,11,19 Fractures that do not heal and progress to a symptomatic nonunion represent a complex problem for patients, ultimately causing prolonged work absence periods in some cases.…”

Clavicle Anatomy

“…The rate of non-union is now thought to be around 10-15 % of all displaced middle third clavicle fractures [ 13 ]. Several randomized control trials have shown improved functional outcomes with internal fi xation of displaced mid-shaft clavicle fractures particularly compared to those patients who develop a non-union [ 14 ]. However between six and eight fractures need to be treated to prevent one non-union, thus it is more prudent to try and predict which patients may develop a nonunion and select these for surgical fi xation.…”