Acute midshaft clavicular fracture.
1Orthopaedic Surgery Education, Greenville Hospital Systems, Greenville, SC 29605, USA.
The Journal of the American Academy of Orthopaedic Surgeons
|April 12, 2007
Summary
Clavicular fractures, especially midshaft ones, often heal well non-surgically. However, complex or displaced fractures may benefit from surgical intervention, though more research is needed.
Area of Science:
- Orthopedic surgery
- Traumatology
Background:
- Clavicular fractures constitute 2.6%–5% of all fractures.
- Midshaft clavicular fractures account for the majority (69%–82%) of clavicle injuries.
- The midshaft is vulnerable due to its thinness and lack of muscular/ligamentous reinforcement.
Purpose of the Study:
- To review the optimal treatment strategies for midshaft clavicular fractures.
- To evaluate the risks associated with nonunion, cosmetic deformity, and poor outcomes in complex cases.
- To identify the need for further research in guiding treatment decisions.
Main Methods:
- Review of existing literature on clavicular fracture treatment.
- Analysis of factors influencing nonunion and outcomes.
- Discussion of surgical versus non-surgical management options.
Main Results:
- Nondisplaced or minimally displaced midshaft fractures typically have a low nonunion rate with conservative management (sling or figure-of-8 dressing).
- Completely displaced or comminuted midshaft fractures, particularly in elderly patients or females, carry a higher risk of nonunion, deformity, and poor outcomes.
- Surgical stabilization (plate-and-screw or intramedullary devices) is proposed for complex midshaft clavicular fractures.
Conclusions:
- Conservative treatment is effective for stable midshaft clavicular fractures.
- Complex midshaft clavicular fractures may warrant surgical consideration due to increased risks.
- Further randomized, prospective trials are essential to optimize treatment decisions for complex midshaft clavicular fractures.
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