Conservative and operative treatment of midshaft clavicular fractures

Nonoperative treatment, e.g. with a sling or a figure-of-eight bandage, has so far been considered to be the gold standard for midshaft clavicle fractures even when substantial displacement has been present. However, more recent studies have shown poorer results following nonoperative treatment of dislocated clavicle fractures compared with operative treatment. The main reasons are a higher nonunion and shortening rate of displaced midshaft fractures, which often result in poor functional outcome and low patient satisfaction. Operative methods, e.g. locking plates or intramedullary fixation technique have proven to have much better outcome in the treatment of midshaft clavicle fractures with displacement and comminution than conservative methods. Adults with a displaced mid shaft fracture have for example a nonunion rate of up to 15% after conservative therapy whereas it is 2-3% after operative treatment. The traditional view that clavicular midshaft fractures no matter what grade of dislocation and what type of fracture should be treated conservatively is no longer valid today. Instead possible complications and risks of the conservative and operative treatment always have to be taken into account and weighed individually for therapy decision-making in the clinical routine. The analysis of current studies shows that patients with dislocated comminuted fractures benefit from surgery.