Nonoperative Treatment of Midshaft Clavicle Fractures in Adults

Sören Waldmann, Emanuel Benninger, Christoph Meier, Sören Waldmann, Emanuel Benninger, Christoph Meier

Abstract

Clavicle fractures are among the most common skeletal injuries accounting for 2-5% of all adult fractures. Historically, nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care. Furthermore, nonoperative treatment has been challenged by an increasing popularity and rate of surgical fixations in recent years despite a lack of clear evidence in the current literature. Most fractures are suitable for conservative treatment. There is solid evidence in favour of nonoperative treatment for fractures with a displacement of less than 2cm and remaining contact of the bone fragments. Clear indications for conservative treatment versus surgical fixation of displaced midshaft fractures have not finally been established yet, leaving some questions and problems unanswered. Furthermore, there are no evidence-based recommendations concerning the kind and duration of shoulder immobilisation with no clear advantage for any treatment modality.

Keywords: Adult; Adults; Clavicle fractures; Conservative; Midshaft; Treatment.

Figures

Fig. (1A)
Fig. (1A)
The antero-posterior radiograph shows an acute multifragmentary midshaft fracture of the clavicle with slight displacement and preserved contact of the bone fragments.
Fig. (1B)
Fig. (1B)
The antero-posterior radiograph of the same fracture at follow-up 16 weeks after trauma demonstrates an only marginal increase of the initial displacement with progressive callus formation.
Fig. (2A-F)
Fig. (2A-F)
Nonoperative treatment advised A. Incomplete B. Alignment C. Minimal displacement D. Dislocated with contact E. Displaced with distance 2cm F. Minor Shortening.
Fig. (3A-E)
Fig. (3A-E)
Operative treatment advised A. Shortening >2cm B. Displaced without contact >2cm C. Skin lession D. Combination with ipsilateral serial rib fractures E. Floating shoulder

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