Midshaft clavicle fractures-when to operate

Midshaft clavicle fractures are some of the most commonly encountered musculoskeletal injuries in orthopaedics. Non-operative treatment for minimally displaced fractures has been widely accepted as the standard of care, while treatment for displaced fractures has remained controversial. However, the last two decades has seen an increase in randomized controlled trials comparing operative and non-operative management of these fractures. Multiple meta-analyses have been performed and demonstrate that operative intervention can significantly reduce the risk of nonunion and improve short-term shoulder function in the appropriate patient. After considering patient comorbidities and functional goals, midshaft clavicle fractures featuring > 2 cm of shortening or >= 100% of displacement should be considered for open reduction and internal fixation. Re-operation rates for implant removal remain high, and patients should be counseled appropriately when considering surgical management.