Displaced Fractures of the Clavicle: Who Should Be Fixed?

Abstract

This study is yet another high-quality, well-designed, and robust (N = 200) randomized clinical trial from a group of investigators who are well recognized for their contributions to evidence-based medicine in the field of orthopaedics. There has been increasing interest in the primary fixation of displaced midshaft fractures of the clavicle since the landmark article by Hill et al., published in 1997, describing a high rate of dissatisfaction following the nonoperative treatment of these injuries1. In the current study, Robinson et al. randomized such individuals to primary plate fixation or a collar and cuff for three weeks. The study design and the inclusion/exclusion criteria (with the study group comprising active healthy patients sixteen to sixty years of age with completely displaced fractures) are nearly identical to those in a number of other recent randomized clinical trials, most of which concluded that primary operative fixation was beneficial for patients2-5. The reader may be justifiably confused by Robinson and colleagues’ conclusion that their results do not support primary plate fixation for these injuries. However, in my opinion, the results of these studies are very similar and complementary, not contradictory, and some clear …