Abstract
Clavicular fractures are the most common fractures in children and adults. Nonoperative management with a sling has been the mainstay of treatment for the past 40 years. However, the algorithm changed after the Canadian Orthopaedic Trauma Society's 2007 article showed that 100% displaced midshaft clavicular fractures performed better after open reduction and internal fixation. Recent trends have focused on less invasive operative techniques. This includes anterior plating as well as intramedullary fixation. Prospective comparative trials also are evaluating outcomes between operative and nonoperative treatment. Multiple prospective, randomized studies have now shown improved clinical outcomes for operative fixation of midclavicular fractures with 100% displacement, severe comminution, and shortening of more than 2 cm. Results show better function, higher patient satisfaction, and lower rates of nonunion and symptomatic malunion.
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