Shaft fractures of the clavicle: current concepts

Abstract

Fractures of the clavicle are common and have been typically addressed to nonoperative treatment. Favorable results, which predominantly were achieved in the young and adolescents, were supposed to be usual in midshaft clavicular fractures. However, in the presence of comminution or complete displacement, especially when occurring in females or elderly patients, there is a marked risk of nonunion, malunion, and poor outcome. Thus, many authors prefer primary surgical stabilization, when risk factors add up. Plate fixation and intramedullary stabilization seem to be equally favored. Though, indications for operative management remain controversial. Further prospective randomized comparative clinical trials are necessary for a well-founded risk-benefit analysis.

Closed vs open nailing for displaced middle third fracture of clavicle. Does it matter?

“…Plate fixation allows anatomic reduction and rigid fixation but the hardware related problems are more common. 1,14 Intramedullary nail fixation offers a less invasive operative option for the fractures of middle third of clavicle. 3,4 While comparing nail fixation to plate fixation for displaced middle third clavicle fractures, some studies have reported superior outcome with nailing while others have reported complications of nailing or no statistical difference in the outcome with these two modalities.…”

“…1 Though conservative treatment is most common, certain situations like open fracture, polytrauma, floating shoulders and need for early mobilization in displaced isolated injuries may warrant operative intervention. 2 Plate fixation has traditionally been operative treatment of choice but nail fixation has proven to be less invasive and better alternative with fewer complications.…”

Mini-open Treatment Using Plate of Clavicle Mid-shaft Fractures

“…5) Treatment options for acute mid-shaft clavicle fractures include open reduction and internal fixation with plates as well as closed or open reduction and internal fixation with intramedullary (IM) pins, wires, or a nail. [6][7][8] Advantages of plate fixation are anatomical reduction, which enables immediate stabilization. Although high success rates of plate fixation have been achieved, reported complications of plate fixation include implant failure, implant prominence, nonunion as a result of extended periosteal stripping, and soft tissue damage.…”

Treatment of Midshaft Clavicle Fractures: Application of Local Autograft With Concurrent Plate Fixation

“…4 In addition, clavicular malunion, which occurs to some degree in approximately two-thirds of midshaft clavicle fractures, was previously described as being solely a radiographic anomaly with no clinical significance. 2,[5][6][7][8] However, more recent studies have suggested that operative treatment results in increased patient satisfaction, superior functional capabilities, and decreased rates of nonunion and malunion when compared with nonoperative management. [9][10][11][12] Operative management of midshaft clavicle fractures may involve the use of various techniques for reduction and fixation.…”