Abstract
Clavicle fractures are among the most common skeletal injuries accounting for 2-5% of all adult fractures. Historically, nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care. Furthermore, nonoperative treatment has been challenged by an increasing popularity and rate of surgical fixations in recent years despite a lack of clear evidence in the current literature. Most fractures are suitable for conservative treatment. There is solid evidence in favour of nonoperative treatment for fractures with a displacement of less than 2cm and remaining contact of the bone fragments. Clear indications for conservative treatment versus surgical fixation of displaced midshaft fractures have not finally been established yet, leaving some questions and problems unanswered. Furthermore, there are no evidence-based recommendations concerning the kind and duration of shoulder immobilisation with no clear advantage for any treatment modality.
Highlights
Clavicle fractures are among the most common skeletal injuries accounting for 2-5% of all adult fractures with an incidence of 29-64 cases per 100.000 [1, 2]
Nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care
Nonoperative treatment has been challenged by an increasing popularity and rate of surgical fixations in recent years despite a lack of clear evidence in the current literature
Summary
Clavicle fractures are among the most common skeletal injuries accounting for 2-5% of all adult fractures with an incidence of 29-64 cases per 100.000 [1, 2]. Sports injuries are responsible for nearly half of all clavicle fractures This group includes in particular young high-demanding male individuals, whereas low-energy fractures in elderly people predominantly result from falls. Nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care. The midshaft is susceptible to fracture where there are no strong ligaments, muscle coverage is absent and the curved bone is weaker. These fractures are usually complete and show an either oblique or transverse, often multifragmentary fracture pattern. In 73%, midshaft fractures are displaced without any contact of the bone fragments [2] (Fig. 2A-F).
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